271' 


hyi 


THE  LIBRARY 

OF 

THE  UNIVERSITY 

OF  CALIFORNIA 

LOS  ANGELES 

GIFT  OF 

SAN  FRANCISCO 
COUNTY  MEDICAL  SOCIETY 


;M.  rfifjr.Tr 


I  I 


Digitized  by  tine  Internet  Arciiive 

in  2007  witii  funding  from 

IVIicrosoft  Corporation 


littp://www.arcli  ive.org/details/dietlistsofpresbOOcartiala 


DIET  LISTS 

OF   THE 

PRESBYTERIAN   HOSPITAL 

NEW  YORK  CITY 

2712 


COMPILED,  WITH^OTKS,  BY 

HERBERT  S.    CARTER,   A.  M.,    M.  D. 

•CONSULTING  PHYSICIAN  TO  THB  LINCOLN  HOSPITAL;    ASSOCIATE   IN   MEDI- 
CINE AT  COLUMBIA   UNIVERSITY,   AND  ASSISTANT  VISITING   PHYSI- 
CIAN TO  THB  PRESBYTERIAN  HOSPITAL,  NEW  YORK  CITY 


Philadelphia  and  London 

W.   B.    SAUNDERS    COMPANY 
1913 


Copyright,  1913,  by  W.  B.  Saunders  Company 


^PRINTED    IN    AMERICA 

PRESS    OF 

W.     B.    SAUNDERS     COMPANV 

PHILADELPHIA 


WB 

/fOO 

HI3 


PREFACE 


The  Diet  Lists  contained  in  this  volume  have  been 
prepared  primarily  for  use  in  the  Presbyterian  Hospital ; 
subsequently  the  comments  on  the  different  diets  were 
added,  for  while  the  indications  for  the  use  of  most  of 
the  diets  is  self-evident,  the  explanatory  notes  add  to 
the  completeness  of  the  presentation  and  may  be  found 
useful  to  some  readers.  The  Table  of  Standard  Por- 
tions was  prepared  originally  by  Prof.  Irving  Fisher,  of 
Yale  University,  through  whose  courtesy  I  am  allowed 
to  use  the  first  part  of  it,  while  the  actual  amounts  of 
Protein,  Carbohydrate,  and  Fat  contained  in  each  por- 
tion was  worked  out  from  Bulletin  No.  28. 

The  Table  of  Food  Values  has  been  taken  from  Bulle- 
tin 28,  1906,  of  the  Department  of  Agriculture,  Atwater 
and  Bryant. 

The  author  wishes  to  express  his  hearty  appreciation 
for  the  assistance  and  advice  given  him  in  the  prepara- 
tion of  this  book  by  Professor  Theodore  C  Janeway,  also 
for  permission  to  use  certain  diet  lists  prepared  by  him; 
to  Dr.  James  C.  Greenway,  for  his  courtesy  in  placing 
at  the  author's  disposal  the  diet  Usts  of  the  New  York 


624155 


Si'Cf  PREFACE 

Hospim,  ana  to  Dr.  Herman  O.  Mosenthal,  for  some 
of  the  diet  lists  used  in  the  Vanderbilt  CHnic,  from 
which  great  assistance  was  derived.  The  author  also 
wishes  to  express  his  appreciation  to  Miss  Selma  Granat, 
for  the  chemical  analyses  of  some  of  the  diets  which 
were  made  by  her  in  the  laboratory  of  the  Presbyterian 
Hospital. 

When  diets  have  been  quoted  in  toto,  due  reference 
is  made  to  the  source  of  information.  The  idea  of  the 
table  of  carbohydrate  equivalents  was  obtained  from 
Von  Noorden's  writings,  but  adapted  to  an  American 
dietary  by  the  author. 

Herbert  S.  Carter. 

New  York  City,   May,  1913. 


CONTENTS 


PAGE 

Introduction i 

Regular  House  Diet — Convalescent  Diet — Soft  Diet s 

Regular  House  Diet S 

Convalescent  Diet 8 

Soft  Diet II 

Milk  Diet ii 

Liquid  Diet ii 

Comments  on  Regular  House  Diet,  Convalescent  Diet,  and 

Soft  Diet II 

Typhoid  Diets 14 

Typhoid  Fluid  Diet  (No.  i) 14 

Typhoid  Fluid  Diet  (No.  2) . . . .' 15 

Modified  Milk  Fluid  Diets 16 

Typhoid  Soft  Diet i8 

Comments  on  Typhoid  Fever  Diet 19 

Salt-poor  Diets 22 

Salt-poor  Diet  (No.  i) 22 

Salt-poor  Diet  (No.  2) 23 

Salt-poor  Diet  (No.  3) * 24 

Comments  on  Use  of  Salt-poor  Diets 24 

Purin-free  Diets 27 

Liquid  Purin-free  Diet 27 

Soft  Purin-free  Diet 27 

Diet  in  Gout 28 

Purin-free  Articles  of  Diet 29 

The  Purin  Bodies  in  Various  Food-stuffs 30 

Comments  on  Purin-free  Diets 32 

V 


vi  CONTENTS 

PAGE 

Gastric  Diets 34 

Lcnhartz  Diet 34 

Convalescent  Gastric  Diets  (No.  i) 48 

Convalescent  Gastric  Diets  (No.  2) 48 

Comments  on  Gastric  Diets 50 

Gastric  Hyperacidity '. ss 

Diabetic  Diets 58 

Standard  Strict  Diet 58 

Standard  Diet  with  Restricted  Protein 59 

Green  Days 60 

General  Diabetic  Diet-lists 61 

Oatmeal  Days 63 

Comments  on  Diabetic  Diet 63 

Anticonstipation  Diet 70 

Comments  on  Anticonstipation  Diet 70 

Low  Calcium  Diet 72 

Comments  on  Low  Calcium  Diet 72 

Fixed  Nitrogen,  Calciimi,  Magnesium  Diet 73 

Diarrhea 74 

Acute  Diarrhea 74 

Chronic  Diarrhea 74 

Obesity  Diet 77 

Comments  on  Obesity  Diet 77 

Gastric  Test  Meals 79 

Comments  on  Test  Meals 79 

Schmidt's  Intestinal  Test  Diet 82 

Comments  on  Schmidt's  Intestinal  Test  Diet 83 

Table  of  Carbohydrate  Equivalents 84 

Special  Diabetic  Recipes 87 

Diabetic  Bread  and  Biscuit 87 

Special  Recipes  for  the  Use  of  Oatmeal 88 

Soja  Bean  Meal 88 


CONTENTS  vii 

Spectal  Diabetic  Recipes —  page 

Desserts 90 

Diabetic  Milk  (Wright's) 91 

Analysis  of  Wright's  Diabetic  Milk 92 

Miscellaneous  Recipes 93 

Protein  Milk  (Eiweissmilch) 95 

Keller's  Malt  Soup 96 

Lactose  Ice-cream 96 

Delafield's  Mixture 97 

Average  Weights  for  Men  and  Women 97 

Average  Chemical  Composition  of  AiiEiacAN  Foods 98 

Standard  Portions iii 

Appendix 119 

Karell  Treatment  for  Anasarca 119 

Comment  on  Karell  Treatment 120 

Gastric  Diet r20 

Von  Leube  Treatment  for  Peptic  Ulcer 120 

Index 123 


DIET   LISTS 

OF  THE 

PRESBYTERIAN   HOSPITAL, 
NEW  YORK   CITY 


INTRODUCTION 

Without  attempting  to  contribute  anything  new  to 
the  science  of  dietetics,  for  which  the  reader  is  referred 
to  any  one  of  the  many  excellent  works  on  this  subject, 
the  author  of  the  present  little  volume  has  in  mind 
merely  the  presentation  of  certain  diets  and  the  prin- 
ciples governing  their  use  from  a  purely  clinical  point 
of  view.  Although  accuracy,  approximately  considered, 
and  not  exhaustiveness  is  aimed  at,  it  is  hoped  that  the 
completeness  of  the  text  will  be  sufficient  for  the  pur- 
pose intended. 

There  is  a  constantly  growing  desire  on  the  part 
of  medical  men  to  utilize  more  exactly  the  therapeutic 
effect  of  foods,  but  many  are  deterred  by  the  seeming 
difficulty  of  the  subject,  and  by  the  lack  of  the  time 
necessary  to  prescribe  an  accurate  diet  list  suited  to 
one  of  the  many  varieties  of  disease.  In  addition, 
1  1 


2  INTRODUCTION 

institutions  in  which  one  would  expect  to  find  an  economy 
in  dietetic  therapeutics,  as  well  as  accurate  methods  for 
arriving  at  desired  results,  are,  for  the  most  part,  sadly 
lacking  in  the  abiHty  to  give  their  inmates  the  benefit  of 
a  well-balanced  ration  and  their  board  of  managers  an 
economic  use  of  food  stuffs.  Hospitals  and  asylums  of 
all  sorts  should  find  an  easy  and  rational  way  to  arrive 
at  a  satisfactory  use  of  food  products. 

The  needs  of  an  individual  who  is  laid  up  by  a  broken 
leg  and  one  convalescing  from  an  acute  or  wasting  in- 
fectious disease  are  quite  different,  yet  many  hospitals 
have  one  standard  diet  for  all  such  cases,  nor  is  allow- 
ance made  for  the  different  requirements  of  men  and 
women  based  on  the  caloric  needs  of  the  body  per  kilo 
of  body  weight. 

In  the  diets  here  presented  advantage  has  been  taken 
of  the  facts  developed  by  Professor  Chittenden's  experi- 
ments, that  physiologic  economy  in  nutrition  can  be 
maintained  on  a  low  level  of  protein,  but  no  attempt 
has  been  made  to  keep  to  such  a  low  standard,  as  this  is 
obtained  best  by  a  gradual  process  of  reduction  in  the 
protein,  whereas  patients  in  general  are  used  to  much 
larger  amounts,  and  convalescents  are  in  need  of  a  cer- 
tain extra  quantity  of  protein  to  make  up  the  loss  due 
to  the  destructive  katabolism  from  acute  disease.  A 
rational  mean  has  been  aimed  at  in  the  quantity  of 
protein  recommended  which  will  allow  a  sufficient 
margin  of  safety  and  still  be  considerably  below  the 


INTRODUCTION  3 

old  standards  of  supposed  protein  requirement.  The 
advantages  to  the  individual  and  to  the  exchequer  of 
the  institution  in  this  are  obvious,  when  one  con- 
siders the  high  cost  of  practically  all  forms  of  protein 
food. 

In  determining  the  number  of  heat  imits  for  men 
and  women,  an  average  weight  of  70  kilos  (154  pounds) 
has  been  assumed  for  men  and  60  kilos  (132  pounds) 
has  been  assumed  for  women  as  the  basis  of  reckoning, 
allowing  30  to  32  calories  per  kilo  of  body  weight, 
which  is  ample  for  an  individual  at  rest  or  light  work. 
This  applies  to  the  regular  house  diet,  soft,  gouty,  and 
anticonstipation  diets.  In  the  convalescent  diet  a 
greater  allowance  is  made,  of  approximately  35  calories 
per  kilo  of  body  weight.  For  obvious  reasons  the 
diabetic  diets  have  a  greater  caloric  value  than  the 
regular  hospital  diets,  as  these  cases  are  so  habitually 
undernourished.  No  hard-and-fast  line  has  been  drawn 
between  the  requirements  of  men  and  women  requiring 
purin-free,  low-calcium,  or  salt-poor  diets,  as  the  cases 
requiring  these  diets  are  never  nimierous  in  a  hospital 
ward. 

The  caloric  value  of  the  primal  food  constituents  may 
be  stated  as  follows  (Reubner) : 

Calories. 

I  gm.  protein 4-i 

I  gm.  fat 9.3 

I  gm.  carbohydrate 4-i 

I  gm.  alcohol 7.0 


4  INTRODUCTION 

The  caloric  needs  of  the  body  under  varying  conditions 
have  been  variously  estimated,  but  the  following  repre- 
sents the  average  per  kilo  of  body  weight  for  a  man 
weighing  70  kilos  (Von  Noorden) : 

Calories. 

Patient  in  bed,  30  calories  per  kilo 2100 

Confined  to  room,  32  to  35  calories  per 

kilo 2240-2450 

Light  exercise,  35  to  40  calories  per  kilo. .  2450-2800 
Moderate  exercise,  40  to  45  calories  per 

kilo 2800-3150 

Very  heavy  labor,  45  to  60  calories  per 

kilo 3150-4200 


REGULAR  HOUSE  DIET— CONVALESCENT   DIET— SOFT 

DIET 

Regular  House  Diet' 
Each  Day  of  the  Week 

Total  quantity  of  milk  allowed,  not  over  750  c.c. 
(i|  pints). 

Breakfast. 

Coffee  or  tea  with  milk  and  sugar,  or  milk. 

Bread  and  butter. 

Two  eggs  to  each  patient  in  male  wards. 

One  egg  to  each  patient  in  female  wards. 

Cereal  with  milk  and  sugar. 

Fresh  fish.        Hash. 

Dinner. 

Soup. 
Meat  or  fish. 
Potatoes  (baked,  boiled,  or  mashed)  and  one  of  the  fol- 
lowing vegetables:   spinach,   squash,   boiled  onions, 
beets,  sweet  potatoes,  macaroni,  tomatoes,  com. 
Bread  and  butter. 
Milk,  180  c.c.  (6  oz.). 
Pudding  or  fruit. 

*  Modified  from  New  York  Hospital  diet  lists. 

5 


REGULAR  HOUSE  DIET 

Supper. 

Tea  or  milk.        Bread  and  butter. 

Cooked  fruit  (prunes,  apples,  or  rhubarb). 

Apricots.    Pears. 

Cold  meat.    Eggs. 

Cereal  with  milk  and  sugar.        Milk-toast. 

Particular  Foods  for  the  Specified  Days 


SUNDAY. 

Breakfast. 

Dinner. 

Supper. 

Wheatina. 

Chicken. 

Cold  meat. 

Eggs. 

Tomatoes. 

Baked  potatoes. 

Fresh  fruit. 

MONDAY. 

Prunes. 

Breakfast. 

Dinner. 

Supper. 

Hominy. 

Vegetable  soup. 

Eggs. 

Bacon. 

Roast  mutton. 
Spinach  or  corn. 
Mashed  potatoes. 

Rice  pudding. 

TUESDAY. 

Apricots. 

Breakfast. 

Dinner. 

Supper. 

Oatmeal. 

Lamb  stew. 

Cereal   with   milk 

Eggs. 

Boiled  potatoes. 

and  sugar. 

Beets. 

Apples. 

Sago  pudding. 

REGULAR  HOUSE  DIET 

WEDNESDAY. 

Breakfast. 

Dinner. 

Supper. 

Wheatina. 

Chicken. 

Cold  meat. 

Fresh  fish. 

Baked  potatoes. 

Rhubarb  or 

Boiled  onions. 

prunes. 

Baked  apples. 

THURSDAY. 

Breakfast. 

Dinner. 

Supper. 

Hominy. 

Pea  soup. 

Milk-toast. 

Eggs. 

Roast  mutton. 
Mashed  potatoes. 

Squash. 
Bread  pudding. 

FRIDAY. 

Baked  apple. 

Breakfast. 

Dinner. 

Supper. 

Oatmeal. 

Fish. 

Eggs. 

Eggs. 

Boiled  potatoes. 
Macaroni  and 

tomatoes. 
Rice  pudding. 

SATURDAY. 

Prunes. 

Breakfast. 

Dinner. 

Supper. 

Cornmeal. 

Vegetable  soup. 

Eggs. 

Hash. 

Meat  stew. 

Mashed  potatoes. 

Spinach  or  corn. 

Cornstarch  pudding, 

Apricots  or  pea 

8  CONVALESCENT  DIET 

Approximate  V allies  to  be  Given 

Total 
Protein.  Carbohydrate.  Fat.  calories. 

Men 90  gm.  (3    oz.).    300  gm.  (10    oz.).     70  gm.  (2I  oz.).     2200 

Women..8o  gm.  (2I  oz.).     250  gm.  (  8|  oz.).    60  gm.  (2    oz.).     1800 

Convalescent  Diet* 
Each  Day  of  the  Week 

Total  quantity  of  milk  allowed,  not  over  1250  c.c. 
(2§  pints)  daily. 
6  A.  M.:  Milk,  210  c.c.  (7  oz.),  if  desired. 

Breakfast. 

Coffee  or  tea  with  milk  and  sugar,  or  milk. 

I  egg,  or  fresh  fish,  or  plain  stew. 

Cereal  with  milk  and  sugar. 

Toast  and   butter  or  rolls  or  bread    (white,  graham 

or  brown). 

Fresh  fish.        Stew. 

Dinner. 

Broth  or  soup  with  barley  or  vegetables. 

Bread  and  butter.        Milk. 

Potatoes,  baked,  boiled,  or  mashed. 

Rice,  macaroni,  or  hominy. 

Beef,  chicken,  or  fish. 

Pudding,  ice-cream,  or 

Fruit. 

*  Modified  from  New  York  Hospital  diet  lists. 


CONVALESCENT  DIET  9 

Supper. 

Tea  or  milk.        Toast  and  butter  or  bread. 
Cooked  fruit  (apples,  stewed  or  baked,  prunes,  rhubarb, 
apricots,  or  pears). 
Egg. 
8  P.  M.:  Milk,  210  c.c.  (7  oz.). 

Particular  Foods  Jor  the  Specified  Days 


SUNDAY. 

Breakfast. 

Dinner. 

Supper. 

Wheatina. 

Chicken. 

Egg. 

I  egg. 

Baked  potato. 
Orange. 

MONDAY. 

Prunes. 

Breakfast. 

Dinner. 

Supper. 

Hominy. 

Roast-beef. 

Egg. 

Stew. 

Mashed  potato. 

Pears  or 

Rice  pudding. 

apricots. 

TUESDAY. 

Breakfast. 

Dinner. 

Supper. 

Oatmeal. 

Fresh  fish. 

Egg. 

I  egg. 

Boiled  potato. 

Hominy. 

Ice-cream. 

Apples  (stewed) 

xo 


CONVALESCENT  DIET 


WEDNESDAY. 

Breakfast. 

Dinner. 

Supper. 

Wheatina. 

Chicken. 

Egg. 

Fresh  fish. 

Baked  potato. 

Rhubarb  or 

Macaroni. 

primes. 

Tapioca  pudding. 

THURSDAY. 

Breakfast. 

Dinner. 

Supper.  • 

Hominy. 

Boiled  beef. 

Egg. 

I  egg. 

Mashed  potato. 

Rice. 
Baked  custard. 

FRIDAY. 

Baked  apple, 

Breakfast. 

Dinner. 

Supper. 

Oatmeal. 

Fresh  fish. 

Egg. 

Egg. 

Boiled  potato. 
Macaroni. 
Ice-cream. 

SATURDAY. 

Prunes. 

Breakfast. 

Dinner. 

Supper. 

Commeal. 

Chicken. 

Egg. 

Stew. 

Mashed  potato. 

Apricots  or 

Hominy. 

pears. 

Cornstarch  pudding. 


Approximate  Values  to  he  Given 

Total 
Protein.  Carbohydrate.  Fat.  Calories. 

Men IOC  gm.  (3I  oz.).    300  gm.  (10  oz.).    90  gm.  (3    oz.).      2500 

Women..  80  gm.  (2f  oz.).    300  gm.  (10  oz.).    80  gm.  (25  oz.).      2200 


soft  diet  ii 

Soft  Diet 

Soft  diet  is  the  same  as  the  convalescent  diet,  omitting 
meat,  fish,  and  green  vegetables. 

Approximate  V allies  to  be  Given 

Total 
Protein.  Carbohydrate.  Fat.  Calories. 

Men. . .  .60  gm.  (2    oz.).     350  gm.  (iif  oz.).     60  gm.  (2    oz.).     2200 
Women..so  gm.  (if  oz.).    300  gm.  (10    oz.).    50  gm.  (if  oz.).     1800 

Milk  Diet 

Milk,  3000  c.c.  (3  quarts).  This  gives:  Protein,  100 
gm.  (3J  oz.);  fat,  120  gm,  (4  oz.);  carbohydrate,  150 
gm.  (5  oz.);  calories,  2160;  chlorids,  5.2  gm. 

Liquid  Diet 

Coffee 165  c.c.  (5I  oz.) 

Broth 675  c.c.  (22^^  oz.) 

Gruel 200  c.c.  (6§  oz.) 

Tea 200  c.c.  (6§  oz.) 

Milk 600  c.c.  (20  oz.) 

Sugar 60  gm.  (2  oz.) 

Egg-albumin 90  gm.  (3  oz.) 

Lemon- juice 60  gm.  (2  oz.) 

This  gives:  Protein,  47  gm.  (i§  oz.);  fat,  28  gm.  (i 
oz.);  carbohydrate,  108  gm.  (3^  oz.);  calories,  900; 
chlorids,  2.6  gm. 

Comments   on  Regular  House  Diet,  Convalescent 
Diet,  and  Soft  Diet 

Regular  house  diet,  convalescent  diet,  and  soft  diet 
speak  for  themselves,  and  are  of  particular  use  in  hospi- 


12  SOFT  DIET 

tal  or  institutional  dietaries.  The  variety  of  foods  in- 
cluded is  considerable,  and  should  one  desire  to  keep 
institutional  expenses  at  a  lower  level,  this  can  be  easily 
done  by  substituting  the  less  expensive  food  stuffs, 
keeping,  however,  to  the  same  general  plan.  Convales- 
cent diet  should  be  of  a  higher  nutritive  value,  more 
easily  digestible,  and  contain  more  protein,  and  this 
change  from  regular  house  diet  is  indicated. 

Soft  diet,  representing  an  intermediate  step  between 
fluid  or  milk  diet  and  convalescent  or  regular  diet,  need 
not  be  so  strictly  adhered  to  in  point  of  food  values,  as  a 
patient's  appetite  can  be  relied  upon  at  this  stage  to 
take  a  sufficient  quantity. 

For  institutions,  however,  it  is  well  to  have  this  also 
standardized  for  economy  in  planning. 

Fluid  diet,  while  it  contains  a  fair  amount  of  protein 
food,  is  of  exceedingly  low  caloric  value,  and  represents 
what  may  be  well  to  give  during  the  first  day  or  two  of 
any  acute  illness,  when  one  wishes  to  rest  the  organism 
without  subjecting  it  to  protein  starvation. 

Milk  diet,  except  as  modified  upward  in  the  typhoid 
milk  diets,  is  of  use  for  a  time,  particularly  in  an  acute 
or  occasionally  in  a  chronic  renal  condition,  its  great 
objection  being  that,  in  order  to  give  the  necessary 
calories  for  a  man,  one  must  give  large  amounts  of  milk, 
3000  to  4000  c.c.  (3  to  4  quarts),  which  would  mean 
that  the  individual  must  consume  100  to  130  gm. 
(3  to  4  oz.)  of  protein,  an  unnecessary  strain  to  put 


SOFT  DIET  13 

upon  excretory  organs  already  disabled  by  disease. 
So  that,  while  we  give  not  more  than  3000  c.c.  (3  quarts) 
per  day  for  milk  diet,  it  must  be  remembered  that  this 
should  not  be  indefinitely  continued. 


TYPHOID  DIETS 
Typhoid  Fluid  Diet  (No.  iy 

8  A.  M.:  Milk  and  coffee,  each  120  c.c.  (4  oz.),  240  c.c. 

(8  oz.). 
10  A.  M.:  Milk,  hot  or  cold,  240  c.c.  (8  oz.). 
12  noon:  Oatmeal  gruel,  120  c.c.  (4  oz.),  with  milk,  60 

c.c.  (2  oz.). 
2  p.  M.:  Milk,  240  c.c.  (8  oz.). 
4  p.  M.:  Oatmeal  gruel,  120  c.c.  (4  oz.),  with  milk,  60 

c.c.  (2  oz.). 
6  P.  M.:  Custard  with  lactose  (full  cup). 
8  p.  M.:  Hot  milk,  240  c.c.  (8  oz.). 
10  p.  M.:  Whey,  180  c.c.  (6  oz.),  with  one  whole  egg  and 

sherry. 
12  p.  M.:  Oatmeal  gruel,  120  c.c.  (4  oz,),  milk,  60  c.c, 

(2  oz.). 
2  A.  M.:  Milk,  240  c.c.  (8  oz.). 
4  A.  M.:  Broth,  240  c.c.  (8  oz.),  with  one  whole  egg. 
6  A.  M.:  Milk,  240  c.c.  (8  oz.). 

Approximate  Values 

Protein,  98  gm.  (3^  oz.);  fat,  52  gm.  (if  oz.);  carbo- 
hydrates, 150  gm.  (5  oz.);  calories,  1900. 

1 F.  P.  Kinnicutt. 
14 


TYPHOID  DIETS  15 

Typhoid  Fluid  Diet  (No.  2)* 

{Lower  Protein) 

8  A.  M.:  Milk  and  coffee,  each  120  c.c.  (4  oz.). 
10  A.  M.:  Milk,  hot  or  cold,  240  c.c.  (8  oz.). 
12  noon:  Oatmeal  gruel,   120  c.c.   (4  oz.),  with  milk, 

60  c.c.  (2  oz.). 
2  p.  M. :  Junket  with  cane-  and  milk-sugar, 
4  p.  M.:  Oatmeal  gruel,  120  c.c.  (4  oz.),  with  milk,  60 

c.c.  (2  oz.). 
6  p.  M. :  Junket  with  cane-  and  milk-sugar. 
8  p.  M.:  Hot  milk,  240  c.c.  (8  oz.). 
10  p.  M.:  Whey,  180  c.c,  with  one  whole  egg  and  sherry. 
12  p.  M.:  Oatmeal  gruel,  120  c.c.   (4  oz.),  with  milk, 

60  c.c.  (2  oz.). 
2  A.  M.:  Junket  with  cane-  and  milk-sugar. 
4  A.  M.:  Milk,  240  c.c.  (8  oz.). 
6  A.  M.:  Milk,  240  c.c.  (8  oz.). 
15  gm.  (^  oz.)  of  lactose  added  to  the  four  milk  feedings. 

Approximate  Values 

Protein,  71  gm.  (2^  oz.);  fat,  81  gm.  (2I  oz.);  carbo- 
hydrates, 160  gm.  (5I  oz.) ;  calories,  2300. 

These  typhoid  fluid  diets  can  be  further  augmented  by 
the  addition  of  the  following  articles: 
Lactose  or  cane-sugar,  30  gm.  (i  oz.),  120  calories. 
Pea  soup  (see  Special  Recipes),  180  c.c.  (i  cup,  6  oz.), 

192  calories  (7.5  gm.  protein). 

IF.  P.  Kinnicutt 


l6  TYPHOID  DIETS 

Bean  soup  (see  Special  Recipes),  i8o  c.c.  (i  cup,  6  oz,), 

242  calories  (12  gm.  protein). 
Soda  cracker  (one),  30  calories  (.5  gm.  protein). 

Cream 100  c.c.  (3I  oz.).  ) 

Sugar  or  lactose. ...     60  gm.  (2   oz.).  /  500 calones. 
Gruel 150  c.c.  (5    oz.).  ) 

This  adds  protein,  5  gm.  (|  oz.) ;  fat,  20  gm.  (|  oz.) ; 
carbohydrates,  75  gm.  (2^  oz.). 

Modified  Milk  Fluid  diets* 

For  1000  calories  a  day:  Calories. 

Milk,  1000  c.c.  (i  quart) 700 

Cream,  50  c.c.  (if  oz.) 100 

Lactose,  50  gm.  (if  oz.) 200 

This  furnishes  eight  feedings,  each  containing : 

Milk,  120  c.c.  (4  oz.) 80 

Cream,  8  gm.  (2  dr.) 15 

Lactose,  6  gm.  (i|  dr.) 24 

For  1500  calories  a  day: 

Milk,  1500  c.c.  (i|  quarts)  1000 

Cream,  50  c.c.  (if  oz.) 100 

Lactose,  100  gm.  (3I  oz.) 400 

This  furnishes  six  feedings,  each  containing: 

Milk,  240  c.c.  (8  oz.) 160 

Cream,  8  gm.  (2  dr.) 15 

Lactose,  16  gm.  (4  dr.) 64 

*  Coleman,  American  Joixmal  of  Medical  Sciences,  January,  191 2. 


TYPHOID  DIETS  17 

For  2000  calories  a  day:  Calories. 

Milk,  1500  c.c.  (i|  quarts) icxx) 

Cream,  240  c.c.  (8  oz.) 500 

Lactose,  1 20  gm.  (4  oz.) 500 

This  furnishes  seven  feedings,  each  containing: 

Milk,  210  c.c.  (7  oz.) 140 

Cream,  30  c.c.  (i  oz.) 60 

Lactose,  18  gm.  (4I  dr.) 72 

For  2500  calories  a  day: 

Milk,  1500  c.c.  (i|  quarts) 1000 

Cream,  240  c.c.  (8  oz.) 500 

Lactose,  240  gm.  (8  oz.) 1000 

This  furnishes  seven  feedings,  each  containing: 

Milk,  210  c.c.  (7  oz.) 140 

Cream,  30  c.c.  (i  oz.) 60 

Lactose,  36  gm.  (9  dr.) 144 

For  3CXD0  calories  a  day: 

Milk,  1500  c.c.  (i§  quarts) 1000 

Cream,  480  c.c.  (i  pint) 1000 

Lactose,  240  c.c.  (  8  oz.) iocx5 

This  furnishes  eight  feedings,  each  containing : 

Milk,  180  c.c.  (6  oz.) 120 

Cream,  60  c.c.  (2  oz.) 120 

Lactose,  30  gm.  (i  oz.) 120 

For  3900  calories  a  day: 

Milk,  1500  c.c.  (i|  quarts) icxx) 

Cream,  480  c.c.  (i  pint) 1000 

Lactose,  480  gm.  (16  oz.) 1900 

2 


l8  TYPHOID  DIETS 

This  furnishes  eight  feedings,  each  containing :        Calonea 

Milk,  i8o  c.c.  (6  oz.) 120 

Cream,  60  c.c.  (2  oz.) 120 

Lactose,  60  gm.  (2  oz.) 240 


Typhoid  Soft  Diet* 

Use  cream,  40  per  cent.  (16  oz.),  for  each 

patient  (Q.  D.) :  Calories. 

6.00  A.  M.  to  8.00  P.  M.:  Pasteurized  milk, 

180  c.c.  (6  oz.) 120 

Cream,  30  c.c.  (i  oz.) 100 

Each  glass 220 

Q.  2  H.    Eight  glasses 1760 

Breakfast.  Calories. 

1  soft-boiled  egg 60 

2  tablespoonfuls  hominy  or  farina  (well  cooked).  100 

With  milk,  90  c.c.  (3  oz.) 60 

With  cream,  60  c.c.  (2  oz.) 200 

420 

Dinner.  Calories. 

Beef-juice,  scraped  beef,  each  30  c.c.  (i  oz.) ...  50 

Oatmeal  gruel,  240  c.c.  (8  oz.) 100 

With  cream,  60  c.c.  (2  oz.) 200 

3  tablespoonfuls  ice-cream 200 

550 

*  L.  A.  Conner,  New  York  Hospital  Diets. 


TYPHOID  DIETS  19 

Supper.  Calories. 

I  soft-boiled  egg 60 

3    tablespoonfuls    wine-jelly    or    custard,    or 

oatmeal  gruel,  240  c.c.  (8  oz.) icxd 

With  cream,  60  c.c.  (2  oz.) 300 

460 

Approximate  values  of  this  diet  are  protein,  loi  gm. 
{7,\  oz.);  carbohydrate,  172  gm.  (5I  oz.);  fat,  176  gm. 
(6  oz.);  calories,  3190. 


Comments  on  Typhoid  fever  Diet 

Many  cases  of  typhoid  when  seen  for  the  first  time, 
either  in  the  hospital  or  private  practice,  have  been  ill 
for  a  number  of  days,  and  are  very  apt  to  have  a  diarrhea, 
which  is  not,  strictly  speaking,  a  part  of  their  disease,  but 
a  complication,  brought  on  by  improper  feeding.  In 
such  cases  it  is  best,  after  the  initial  emptying  of  the 
intestinal  canal  by  mild  catharsis  or  enemata,  to  pre- 
scribe a  diet  which,  while  it  is  too  low  in  heat  units, 
still  has  a  fair  amount  of  protein,  and  has  an  added  ad- 
vantage over  a  strictly  milk  diet  in  that  it  is  quite  varied 
in  composition.  Such  a  diet  is  given  in  the  t5^hoid 
liquid  diets,  and,  while  one  could  often  advantageously 
give  the  ordinary  fluid  diet  for  this  period,  the  special 
t3rphoid  liquid  diet  furnishes  almost  twice  as  much 
protein  and  twice  as  many  calories. 

When  the  patient  is  ready  for  more  food  this  list  of 


20  TYPHOID  DIETS 

articles  can  be  further  reinforced  by  the  addition  of 
cream,  lactose,  eggs,  and  more  gruel,  or  one  can  make 
use  of  one  of  the  cream,  milk,  and  lactose  mixtures  given 
in  the  diet  lists  devised  by  Dr.  Warren  Coleman.  There 
is,  however,  a  distinct  advantage  in  the  greater  variety 
of  foods  in  the  first  list,  and  it  has  been  the  experience 
of  many  that  it  is  better  borne.  In  early  convalescence 
the  soft  typhoid  diet  will  be  found  convenient,  as  repre- 
senting a  good  amoimt  of  protein  and  a  larger  number  of 
calories  without  irritating  or  coarse  residue.  There  is 
apparently  no  question  among  clinicians  nowadays  that 
typhoid  patients  do  better  on  a  more  hberal  supply  and 
variety  of  foods  than  on  a  monotonous  and  insufl5cient 
milk  diet — complications  are  fewer  (?)  and  convalescence 
is  shortened.  Coleman  and  Schaefer  have  ably  demon- 
strated that  the  body  is  able,  even  in  high  fever,  to 
digest,  absorb,  and  properly  utilize  quantities  of  food 
sufiSdently  large  to  maintain  nitrogenous  equilibrium  and 
body  weight,  their  cases  often  actually  gaining  weight 
during  the  fever. 

There  never  was  a  class  of  patients,  however,  who 
needed  more  individual  care  in  the  selection  of  the  kind 
and  quantity  of  food  given  than  typhoid  fever  patients, 
and,  while  the  high  caloric  feeding  is  a  great  step  in 
advance,  it  must  be  individualized  for  the  patient  and 
always  arrived  at  gradually;  i.  e.,  it  is  not  well  to  go  from 
a  low  caloric  to  a  high  caloric  diet  without  a  gradual 
increase  from  one  to  the  other. 


TYPHOID  DIETS  21 

Just  here  it  might  be  added  that  when  a  patient's 
digestion  fails  to  take  care  of  the  larger  amounts  of  food, 
as  shown  by  tympanites,  flatulence,  etc.,  the  use  of 
buttermilk  or  milk  artificially  ripened  by  some  form  of 
the  lactic  acid  bacillus  (see  Special  Recipes),  if  given  in 
moderate  amount  wherever  fresh  milk  is  being  used, 
will  often  stop  the  intestinal  fermentation  at  once.  It 
is  almost  as  useful  when  a  patient's  stomach  becomes 
disturbed,  as  shown  by  nausea  or  vomiting. 

The  transition  from  typhoid  soft  to  convalescent  diet 
is  easily  made,  although  fruits  and  green  vegetables 
should  be  excluded  at  first. 


SALT-POOR  DIETS 

Salt-poor  Diet  No.  J 

Breakfast.                Gm.  Oz. 

Bread 30  i 

Sugar 10  \ 

Farina 60  2 

Butter 30  I 

Egg  (i) 40  I3 

Coffee 150  c.c.    5 

320  lof 

Dinner.                  Gm.  Oz. 

Bread 30  i 

Butter 20  f 

Sugar. 10  \ 

Rice 60  2 

Farina 100  3I 

Tea 150  c.c.    5 

370  12^ 

Supper.                Gm.  Oz. 

Egg  (i) 40  i^ 

Toast 15  I 

Bread 30  i 

Butter 15  § 

Custard 100  3^ 

Prunes 60  2 

Tea 180  c.c.    6 


440         14! 


22 


SALT-POOR  DIETS  23 

This  contains  chlorids,  i  gm.;  protein,  35  gm.  (i|  oz.); 

fat,  65  gm.  (2I  oz.);  carbohydrate,  140  gm.  (4I  oz.); 
calories,  1300. 

Salt-poor  Diet  No.  2 

Breakfast.                Gm.  Oz. 

Bread 60  2 

Sugar 40  i^ 

Farina 60  2 

Butter 35  i| 

Egg  (i) 40  I3 

Coffee 150  CO.  5 

38s  i2| 

Dinner.                  Gm.  Oz. 

Egg  (i) 40  li 

Bread 60  2 

Butter 30  I 

Rice 70  2\ 

Farina 100  3I 

Tea 150  c.c.  5 

450  IS 

Supper.                 Gm.  Oz. 

Egg  (i) 40  i^ 

Toast IS  \ 

Bread 60  2 

Butter 30  I 

Custard 100  3^ 

Prunes 60  2 

Tea 180  c.c.    6 

48s  15I 


24  SALT-POOR  DIETS 

This  contains  chlorids,  1.3  gm;  protein,  50  gm.  (if  oz.) ; 
fat,  100  gm.  (3§  oz.);  carbohydrate,  240  gm.  (8  oz.); 
calories,  2100. 

SALT-POOR  Diet  No.  3 
Same  as  convalescent  diet,  without  broths  or  soups. 
The  fish,  meat,  and  green  vegetables  must  be  boiled  in 
two  waters  to  remove  most  of  the  salt.    Milk,  250  c.c. 
(8  oz.),  only  allowed.^ 

Comments  on  Use  of  Salt-poor  Diets 
In  the  use  of  salt-poor  diets,  or  so-called  salt-" free" 
diets  (although  none  of  them  can  be  actually  salt  free), 
a  great  step  in  advance  has  been  made  in  the  dietetic 
treatment  of  edema,  particularly,  but  not  exclusively, 
of  renal  origin.  We  are  more  indebted  to  Widal  than 
to  any  other  one  man  for  putting  this  therapeutic 
measure  on  a  firm  basis.  Of  course,  it  is  particularly 
useful  in  edema  associated  with  a  greater  or  lesser  de- 
gree of  impermeabihty  of  the  kidney  to  salt.  The  two 
requisites  for  the  successful  use  of  this  form  of  treatment 
are,  proper  selection  of  cases  and  the  continued  and 
faithful  use  of  a  diet  that  is  as  nearly  salt  free  as  possible. 
In  other  words,  while  the  edema  in  many  cases  of  this 
kind  begins  to  clear  up  at  once  on  this  diet  (although  it 
has  resisted  all  other  physical  and  medical  measures), 

*  In  all  the  salt-poor  diets  the  food  should  be  prepared  absolutely 
without  addition  of  salt.  Salt-free  butter  and  bread  only  are  to  be 
used.    No  extra  salt  allowed. 


SALT-POOR  DIETS  2$ 

in  many  of  them  it  does  not,  and  it  is  not  until  the  pa- 
tients have  been  on  this  diet  for  a  week  or  two  or  longer 
that  apparently  the  kidneys,  having  been  spared  so 
long,  are  able  to  regain  their  lost  power  of  salt  excre- 
tion, and  will  then  go  ahead  and  rapidly  empty  the 
subcutaneous  tissue  of  its  retained  salt  and  water. 

While  it  is  best  to  determine  the  rapidity  of  the  salt 
elimination  in  cases  in  which  the  edema  resists  the 
dietary,  so  that  one  can  be  assured  that  one  is  on  the 
right  track,  a  clinical  diagnosis  can  often  be  made  when 
the  edema  is  diminished  promptly.  While,  as  already 
stated,  this  treatment  is  particularly  indicated  in  a 
special  class  of  renal  disease,  it  is  of  great  assistance  in 
many  forms  of  edema  or  even  serous  effusions.  This  is 
due  no  doubt  to  the  fact  that  the  kidneys  are  spared 
extra  labor  in  the  excretion  of  the  usual  amoimt  of 
salt  taken  with  the  normal  diet,  and  to  the  fact  that  the 
body,  in  the  presence  of  a  reduced  salt  intake,  seeks 
salt  in  the  tissues  or  serous  spaces  in  order  to  keep  up 
the  normal  salt  concentration  in  the  urine,  as  an  at- 
tempt at  equilibrium  of  the  inorganic  constituents  of 
the  urine  is  in  some  way  automatically  arranged  for. 

With  this  foreword,  the  use  of  the  salt-poor  diets 
becomes  evident  and  needs  little  or  no  further  explana- 
tion. 

No.  I  should  be  used  first,  then  No.  2,  and  finally, 
when  safe,  No.  3.  The  length  of  time  each  should  be 
used  is  a  matter  for  individual  judgment,  but  No.  2 


26  SALT-POOR  DIETS 

should  not  be  used,   if   possible,   until,   all  edema  is 

gone,  and  has  been  absent  long  enough  presumably  to 

give  the  kidney  rest/ 

^  Detennination  of  total  chlorids  in  xirine:  Dilute  lo  c.c.  of  urine 
with  90  c.c.  of  water,  add  i  or  2  drops  of  25  per  cent,  nitric  acid. 
Make  the  mixture  alkaline  with  10  per  cent,  solution  of  sodium  car- 
bonate, and  add  a  few  drops  of  10  per  cent,  potassium  chromate  solu- 
tion as  an  indicator.  Titrate  with  xV  normal  silver  chlorid  solution. 
Each  cubic  centimeter  of  the  silver  solution  used  equals  .00583  gm. 
sodium  chlorid. 


PURIN-FREE  DIETS 

Liquid  Purin-free  diet 

(FoLEsr) 

Whole  milk 500  c.c.  (16  oz.). 

Cream  (18  to  22  per  cent,  fat) . . .  300  c.c.  (10  oz.). 

10  eggs  (whites  and  yolks) 450  gm.  (15  oz.), 

Horlick's  malted  milk 200  gm.  (6f  oz.). 

Sugar 20  gm.  (f  oz.). 

NaCl 6  gm.  (^  oz.). 

Water q.  s.  ad.  2000  c.c.  (64  oz.). 

Extra  water 900  c.c.  (30  oz.). 

Yields 

Protein 139  gm.  (4!  oz.) 

Fat 146  gm.  (4^  oz.)     2830  calories. 

Carbohydrate.  .  .225  gm.  (7I  oz.)  . 

Soft  Purin-free  Diet» 
6  A.  M.:  Milk,  180  c.c.  (6  oz.). 
8  A.  M. — Breakfast: 
Milk,  180  c.c.  (6  oz.). 
i|  slices  of  bread  and  i  pat  of  butter. 
2  tablespoonfuls  wheatina  or  cream  of  wheat  with 
cream,  60  c.c.  (2  oz.),  and  2  tablespoonfuls  of 
sugar. 
I  soft-boiled  egg. 

^  Vanderbilt  Clinic  diet  lists. 

27 


28  PURIN-FREE  DIETS 

12  M. — Dinner: 

Milk,  i8o  ex.  (6  oz.). 

I  soft-boiled  egg,  S.  O.  S. 

Potato  with  cream,  30  c.c.  (i  oz.),  and  i  pat  of 

butter. 
Lettuce  or  cabbage  with  dressing, 
i^  sHces  of  bread  with  i  pat  of  butter. 

3  p.  M.:  Milk,  180  c.c.  (6  oz.). 

5  p.  M. — Supper: 

I  soft-boiled  egg,  S.  O.  S. 

Milk,  180  c.c.  (6  oz.). 

2^  tablespoonfuls  of  rice  with  cream,  30  c.c.  (i  oz.), 

and  I  tablespoonful  of  sugar. 
Crackers  with  butter,  i  pat. 
I  cube  of  cheese  (2  inches). 

1  cup  of  weak  tea  with  cream,  30  c.c.  (i  oz.),  and 
I  teaspoonful  of  sugar,  S.  0.  S. 

8  p.  M.:  Milk,  180  c.c.  (6  oz.). 

Protein,  80  gm.  (2I  oz.);  fat,  112  gm   (3!  oz.);  car- 
bohydrate, 207  gm.  (7  oz.) ;  calories,  2300. 

Diet  in  Gout* 
Breakfast: 
Any  fresh,  cooked,  or  preserved  fruit. 
Cereal  with  sugar  and  milk  or  cream. 
White  bread,  toast,  muffins,  biscuits,  butter. 

2  eggs  (any  style). 

Milk,  with  slight  amount  of  coffee,  tea,  or  cocoa. 

*  Modified  from  Von  Noorden. 


PURIN-FREE  DIETS  29 

Lunch  and  Dinner: 

Soups. — Cream,  potato,  or  from  any  vegetable 
given  below,  prepared  without  meat  or  meat 
extract. 

Eggs,  any  style. 

Meat  and  Fish. — Once  a  day  one  of  the  following: 
Ham,  boiled  beef,  boiled  chicken,  boiled  mutton, 
pot  roast,  any  boiled  fish. 

Vegetables. — Potatoes,  sweet  potatoes,  cauliflower, 
lettuce,  cabbage,  spinach,  okra,  egg-plant,  com, 
Brussels  sprouts,  rice,  macaroni,  noodles. 

Bread. — Crackers,  white  bread,  toast,  butter. 

Desserts. — Fresh,  cooked,  or  preserved  fruit,  all 
desserts  (ice-cream,  pudding,  cake,  pie,  etc.)  not 
flavored  with  coffee  or  chocolate,  American,  Swiss, 
and  cream  cheese. 

Beverages. — Milk,  cider,  water,  Vichy  or  any  car- 
bonated water.  Grape-jmce  and  raspberry  syrup 
allowed. 


Approximate  Values  to  he  Given 

Total 
Protein.  Carbohydrate.  Fat.  calories. 

Men 6ogm.  (2    oz.).    350  gm.  (ii|  oz.).    60  gm.  (2    oz.).     22cx) 

Women..sogm.  (if  oz.).     300  gm.  (10    oz.).     50  gm.  (if  oz.).     1800 


PuRiN-FREE  Articles  of  DrnT^ 
Milk. 
Eggs. 

Bread,  white  only  (not  graham  or  whole  wheat). 
Butter. 

1  Vanderbilt  Clinic  diet  lists. 


3©  PURIN-FREE  DIETS 

Biscuits. 

Cereals  (hominy,  rice,  farina). 

Cream. 

Sugar  and  syrup. 

Jam  and  marmalade. 

Cake. 

Cream  soups. 

Vegetables: 

Potatoes  (slight  amount  of  purin). 

Cauliflower. 

Cabbage. 

Lettuce. 

Egg-plant. 
Desserts: 

Nuts. 

Cheese. 

Ice-cream  and  water-ices. 

Cake   (any  cake  except  with  coffee  or  chocolate 
flavor). 

Rice,  bread,  farina,  tapioca,  or  cornstarch  pudding. 

Custard  or  cocoanut  pie. 

The  Purin  Bodies  in  Various  Food-stuffs  ^ 

.  Purin  bodies, 

"^^^"  grams  per  kilo. 

Cod 0.5 

Plaice 0.7 

Salmon i.i 

Halibut i.o 


1  Hall  J.  Walker,  The  Purin  Bodies  of  Food  Stuffs  and  the  R61e  of 
Uric  Acid  in  Health  and  Disease,  2d  ed.  rev.,  London,  1903. 


PURIN-FREE  DIETS  3I 

Meat:  Purin  bodies, 

grams  per  kilo. 

Beef 1.3-2.0 

Fat I.I 

Mutton 0.96 

Fat 

Veal I.I 

Fat 

Pork 1.2 

Fat 0.5 

Ham I.I 


Meat  soups  (varying  large  amoimts). 
Chicken 1.2 


Vegetables: 

Potatoes 0.02 

Rice 

Flour  (white) 

Bread  (white) 

Oatmeal 0.53 

Peas 0.39 

Lentils 0.38 

Beans  (Haricot) 0.63 

Asparagus 0.21 

Cabbage 

Lettuce 

Cauliflower 

Onions 0.09 

Tapioca 


32  PURIN-FREE  DIETS 

Special  Foods:  Purin  bodies, 

grams  per  kilo. 

Milk 

Butter 

Eggs 

Cheese  (fat) 

Drinks: 

Beer,  lager 0.12 

Ale 0.14 

Porter 0.15 

Per  pint 
(500  c.c). 

Tea 1,2 

Cocoa 1.0 

Chocolate 0.7 

Coffee 1.7 

Claret 

Sherry — 

Port 

Comments  on  Purin-free  Diets 
Since  in  gout  the  purin  metabolism  is  faulty,  the  aim 
of  its  dietetic  treatment  should  be  to  furnish  a  food 
containing  little  or  no  purin  bodies. 

In  the  liquid  purin-free  diet,  as  designed  by  Folin, 
we  have  a  diet  that  is  useful  almost  exclusively  for  scien- 
tific purposes,  when  one  wishes  to  determine  the  amount 
of  endogenous  uric  acid  that  is  excreted.  It  can,  how- 
ever, be  used  to  advantage  during  an  acute  attack  of 
gout. 


PURIN-FREE  DIETS  33 

The  soft  purin-free  diet  can,  for  the  most  part,  be 
used  in  acute  gout,  and  is  much  more  palatable.  The 
amount  of  protein  or  the  total  calories  can  be  reduced 
or  increased  at  will  to  meet  the  requirements  of  large 
or  small  individuals.  The  list  given  is  suflScient  for  a 
man  of  70  kilos  (154  poimds).  Women  seldom  have 
acute  gout. 

The  Hst  of  purin-free  articles  of  diet  is  inserted  to 
help  one  prescribe  a  variety  in  case  the  diet  is  continued 
for  some  time. 

The  diet  given  specifically  for  gout  can  be  modified 
from  the  purin-free  list  as  well,  and,  while  this  diet 
for  gout  is  not  absolutely  purin  free,  it  is  of  a  low  purin 
content,  and  boiling  the  meats,  particularly  if  they  are 
boiled  in  two  waters,  removes  a  great  part  of  the  purins. 
3 


GASTRIC  DIETS 

Lenhartz  Diet 

As  eggs  differ  in  size  and  weight,  take  the  total  of 
eggs  for  the  day  of  diet;  beat,  measure,  and  divide  into 
seven  feedings  and  put  into  medicine-glasses.  Keep  on 
ice  and  use  as  directed,  alternating  with  milk. 

Milk,  iced,  kept  in  bowl  of  cracked  ice.  Eggs  beaten 
up  raw  and  iced.    Spoon  kept  in  bowl  of  ice. 

Patients  never  allowed  to  help  themselves. 

Slow  feedings  essential,  frequent  small  feedings  fed 
by  spoon. 

First  and  second  days  salt  eggs  to  taste. 

Third  day  sugar  is  started. 

First  Day 

7  A.M.:  Egg. 

8  A.  M.:  Milk,  20  c.c.  (f  oz.). 

9  A.M.:  Egg. 

10  A.  M.:  Milk,  20  c.c.  (f  oz.). 

11  A.  M.:  Egg. 

12  noon:  Milk,  15  c.c.  (^  oz.). 

1  p.  M.:  Egg. 

2  p.  M.:  Milk,  15  c.c.  (|  oz.). 

3  P.M.:  Egg. 

4  p.  M.:  Milk,  15  c.c.  (§  oz.). 

34 


GASTRIC  DIETS  35 

5  P.M.:  Egg. 

6  p.  M.:  MiJk,  15  c.c.  (|  oz.). 

7  P.M.:  Egg. 

Total  First  Day. — Eggs  (raw),  2;  milk,   100  c.c.   (3I 
oz.). 

Second  Day 

7  A.M.:  Egg. 

8  A.  M.:  Milk,  35  c.c.  (i  oz.). 

9  A.M.:  Egg. 

10  A.  M.:  Milk,  35  c.c.  (i  oz,). 

11  A.  M.:  Egg. 

12  noon:  Milk,  35  c.c.  (i  oz.). 
IP.  M.:  Egg. 

2  p.  M.:  Milk,  35  c.c.  (i  oz.). 

3  P.M.:  Egg. 

4  p.  M.:  Milk,  30  c.c.  (i  oz.). 

5  P.M.:  Egg. 

6  p.  M.:  Milk,  30  c.c.  (i  oz.). 

7  P.M.:  Egg. 

Total  Second  Day. — Eggs  (raw),  3;  milk,   200  c.c. 
(6f  oz.). 

Third  Day 

7  A.M.:  Egg. 

Sugar,  2  gm.  (|  dr.). 

8  A.  M.:  Milk,  50  c.c.  (if  oz.). 

9  A.M.:  Egg. 

Sugar,  3  gm.  (f  dr.). 

10  A.  M.:  Milk,  50  c.c.  (if  oz.). 

11  A.  M. :  Egg. 

Sugar,  3  gm.  (|  dr.). 

12  noon:  Milk,  50  c.c.  (if  oz.). 


36  GASTRIC  DIETS 

1  P.  M.:  Egg. 

Sugar,  3  gm.  (f  dr.). 

2  p.  M.:  Milk,  so  c.c.  (if  oz.). 

3  p.  M.:  Egg. 

Sugar,  3  gm.  (f  dr.). 

4  p.  M.:  Milk,  50  c.c.  (if  oz.). 

5  P.M.:  Egg. 

Sugar,  3  gm.  (f  dr.). 

6  P.  M.:  Milk,  50  c.c.  (if  oz.). 

7  p.  M.:  Egg. 

Sugar,  3  gm.  (f  dr.). 
Total  Third  Day. — Eggs  (raw),  4;  milk,  300  c.c.  (10 
oz.);  sugar,  20  gm.  (5  dr.). 

Fourth  Day 

7  A.M.:  Egg. 

Sugar,  2  gm.  (|  dr.). 

8  A.  M.:  Milk,  70  c.c.  (2I  oz.). 

9  A.M.:  Egg. 

Sugar,  3  gm.  (f  dr.). 

10  A.  M.:  Milk,  70  c.c.  (2^  oz.). 

11  A.  M.:  Egg. 

Sugar,  3"gm.  (f  dr.). 

12  noon:  Milk,  65  c.c.  (2  oz.). 

1  P.M.:  Egg. 

Sugar,  3  gm.  (f  dr.). 

2  p.  M.:  Milk,  65  c.c.  (2  oz.). 

3  p.  M.:  Egg. 

Sugar,  3  gm.  (f  dr.). 

4  p.  M.:  Milk,  65  c.c.  (2  oz.). 

5  P.M.:  Egg. 

Sugar,  3  gm.  (f  dr.). 


GASTRIC  DIETS  37 

6  P.  M.:  Milk,  65  c.c.  (2  oz.). 

7  P.M.:  Egg. 

Sugar,  3  gm.  (f  dr.). 
Total  Fourth  Day. — Eggs  (raw),  5;  milk,  400  c.c. 
(13I  oz.);  sugar,  20  gm.  (5  dr.). 

Fifth  Day 

7  A.M.:  Egg. 

Sugar,  4  gm.  (i  dr.). 

8  A.  M.:  Milk,  80  c.c.  {2%  oz.). 

9  A.  M.':  Egg. 

Sugar,  4  gm.  (i  dr.). 

10  A.  M.:  Milk,  80  c.c.  (2I  oz.). 

11  A.  M.:  Egg. 

Sugar,  4  gm.  (i  dr.). 

12  noon:  Milk,  80  c.c.  {2%  oz.). 

1  p.  M.:  Egg. 

Sugar,  4I  gm.  (i  dr.). 

2  p.  M.:  Milk,  80  c.c.  (2I  oz.). 

3  P.M.:  Egg. 

Sugar,  4§  gm.  (i  dr.). 

4  p.  M.:  Milk,  80  c.c.  {2%  oz.). 

5  P.M.:  Egg. 

Sugar,  4I  gm.  (i  dr.). 

6  P.  M.:  Milk,  90  c.c.  (3  oz.). 

7  P.M.:  Egg. 

Sugar,  4^  gm.  (i  dr.). 
Total  Fifth  Day. — Eggs  (raw),  6;  milk,  500  c.c.  (i6f 
oz.);  sugar,  30  gm.  (i  oz.). 

Sixth  Day 
7  A.M.:  Egg. 

Sugar,  4  gm.  (i  dr.). 


38  GASTRIC  DIETS 

8  A.  M.:  Milk,  icx>  c.c.  (3^  oz.). 

9  A.M.:  Egg. 

Sugar,  4I  gm.  (i  dr.). 
Scraped  beef,  12  gm.  (3  dr.). 

10  A.  M.:  Milk,  100  c.c.  (3I  oz.). 

11  A.  M.:  Egg. 

Sugar,  4^  gm.  (i  dr.). 

12  noon:  Milk,  100  c.c.  (3I  oz.). 

1  p.  M. :  Egg. 

Sugar,  4I  gm.  (i  dr.). 
Scraped  beef,  12  gm.  (3  dr.). 

2  p.  M.:  Milk,  IOC  c.c.  (3I  oz.). 

3  P.M.:  Egg. 

Sugar,  4§  gm.  (i  dr.). 

4  p.  M.:  Milk,  100  c.c.  (3I  oz.). 

5  P.M.:  Egg. 

Sugar,  4  gm.  (i  dr.).  • 
Scraped  beef,  12  gm.  (3  dr.). 

6  P.  M.:  Milk,  100  c.c.  (3I  oz.). 

7  P.M.:  Egg. 

Sugar,  4§  gm.  (i  dr.). 
Total  Sixth  Day. — Eggs  (raw),  7;  milk,  600  c.c.  (20 
oz,);  sugar,  30  gm.  (i  oz.);  scraped  beef,  36  gm.  (9  dr.). 

Seventh  Day 

7  A.  M. :  I  soft-boiled  egg. 

8  A.  M.:  Milk,  100  c.c.  (3I  oz.). 

9  A.M.:  Egg. 

Sugar,  13  gm.  (3  dr.). 
10  A.  M.:  Milk,  IOC  c.c.  (3I  oz.). 

Scraped  beef,  23  gm.  (6  dr.). 
Boiled  rice,  33  gm.  (i  oz.). 


GASTRIC  DIETS  39 

11  A.  M.:  I  soft-boiled  egg. 

12  noon:  Milk,  125  c.c.  (4  oz.). 

1  p.  M.:  Egg. 

Sugar,  13  gm.  (3  dr.). 

2  p.  M.:  Milk,  125  c.c.  (4  oz.). 

Scraped  beef,  23  gm.  (6  dr.). 
Boiled  rice,  33  gm.  (i  oz.). 

3  p.  M. :  I  soft-boiled  egg. 

4  p.  M.:  Milk,  125  c.c.  (4  oz.). 

5  P.M.:  Egg. 

Sugar,  14  gm.  (3I  dr.). 

6  p.  M.:  Milk,  125  c.c.  (4  oz.). 

Scraped  beef,  24  gm.  (6  dr.). 
Boiled  rice,  34  gm.  (i  oz.). 

7  p.  M. :  I  soft-boiled  egg. 

Total  Seventh  Day. — Eggs  (raw),  4;  soft  boiled,  4; 
milk,  700  c.c.  (23I  oz.) ;  sugar,  40  gm.  (i|  oz.) ;  scraped 
beef,  70  gm.  (2^  oz.);  boiled  rice,  100  gm.  (3^  oz.),  served 
with  beef- juice. 

Eighth  Day 

Diet  changes  on  the  eighth  day,  requiring  only  4  raw 
eggs,  which  may  be  divided  into  three  feedings.  The 
other  4  eggs  are  to  be  soft  boiled  and  given  as  directed 
by  diet. 

7  A.  M. :  I  soft-boiled  egg. 

8  A.  M.:  Milk,  135  c.c.  (4I  oz.). 

9  A.M.:  Egg. 

Sugar,  13  gm.  (3  dr.). 
10  A.  M.:  Milk,  133  c.c.  (4^  oz.). 

Scraped  beef,  23  gm.  (6  dr.). 
Boiled  rice,  33  gm.  (i  oz.). 


40  GASTRIC  DIETS 

11  A.  M.:  I  soft-boiled  egg. 

Zwieback,  lo  gm.  (2^  dr.). 

12  noon:  Milk,  133  c.c.  (4^  oz.). 

1  p.  M. :  Egg. 

Sugar,  13  gm.  (3  dr.). 

2  p.  M.:  Milk,  133  c.c.  (4I  oz.). 

Scraped  beef,  23  gm.  (6  dr.). 
Boiled  rice,  33  gm.  (i  oz.). 

3  p.  M. :  I  soft-boiled  egg. 

4  p.  M.:  Milk,  133  c.c.  (4I  oz.). 
SP.  M.:  Egg. 

Sugar,  14  gm.  (3I  dr.). 
Zwieback,  10  gm.  (2I  dr.). 

6  p.  M.:  Milk,  133  c.c.  (4^  oz.). 

Scraped  beef,  24  gm.  (6  dr.). 
Boiled  rice,  34  gm.  (i  oz.). 

7  p.  M. :  I  soft-boiled  egg. 

Total  Eighth  Day. — Eggs  (raw),  4;  soft  boiled,  4; 
milk,  800  c.c.  (26I  oz.);  scraped  beef,  70  gm.  (2I  oz.); 
boiled  rice,  100  gm.  (3I  oz.);  zwieback,  20  gm.  (5  dr.); 
sugar,  40  gm.  (i|  oz.). 


Ninth  Day 

7  A. 

M.: 

;  I  soft-boiled  egg. 

8  A. 

M.: 

:  Milk,  150  c.c.  (5  oz.). 

9  A. 

M.: 

Egg. 

Sugar,  13  gm.  (3  dr.). 

10  A. 

M.: 

Milk,  150  c.c.  (5  oz.). 
Scraped  beef,  23  gm.  (6  dr.). 
Boiled  rice,  66  gm.  (2  oz.). 

II  A. 

M.: 

:  I  soft-boiled  egg. 
Zwieback,  20  gm.  (5  dr.). 

GASTRIC  DIETS  41 

12  noon:  Milk,  150  c.c.  (5  oz.). 

1  p.  M. :  Egg. 

Sugar,  13  gm.  (3  dr.). 

2  p.  M.:  Milk,  150  c.c.  (5  oz.). 

Scraped  beef,  23  gm.  (6  dr.). 
Boiled  rice,  67  gm.  (2  oz.). 

3  p.  M. :  I  soft-boiled  egg. 

Zwieback,  20  gm.  (5  dr.). 

4  p.  M.:  Milk,  150  c.c.  (5  oz.). 

5  P.M.:  Egg. 

Sugar,  14  gm.  (3I  dr.). 

6  p.  M.:  Milk,  150  c.c.  (5  oz.). 

Scraped  beef,  24  gm.  (6  dr.). 
Boiled  rice,  67  gm.  (2  oz.). 

7  p.  M. :  I  soft-boiled  egg. 

Total  Ninth  Day. — Eggs  (raw),  4;  cooked,  4;  milk, 
900  c.c.  (30  oz.);  sugar,  40  gm.  (if  oz.);  scraped  beef, 
70  gm.  (2I  oz.);  rice,  200  gm.  (6|  oz.);  zwieback, 40  gm. 
(i|  oz.),  or  toast,  20  gm.  (5  dr.). 


Tenth  Day 

7  A.  M.:  I  soft-boiled  egg. 

8  A.  M.:  Milk,  166  c.c.  (5!  oz.). 

9  A.M.:  Egg. 

Sugar,  13  gm.  (3  dr.). 

10  A.  M.:  Milk,  168  c.c.  (5I  oz.). 

Scraped  beef,  23  gm.  (6  dr.). 
Boiled  rice,  66  gm.  (2  oz.). 

11  A.  M.:  I  soft-boiled  egg. 

Zwieback,  20  gm.  (5  dr.). 
Butter,  4  gm.  (i  dr.). 


42  GASTRIC  DIETS 

12  noon:  Cooked  chopped chicken,,2 5  gin.(6  dr.). 
Milk,  166  c.c.  (5^  oz.). 

1  p.  M. :  Egg. 

Sugar,  13  gm.  (3  dr.). 

2  p.  M.:  Milk,  166  c.c.  (5^  oz.). 

Scraped  beef,  23  gm.  (6  dr.). 
Boiled  rice,  66  gm.  (2  oz.). 
Butter,  4  gm.  (i  dr.). 

3  p.  M. :  I  soft-boiled  egg. 

Zwieback,  20  gm.  (5  dr.). 
Butter,  4  gm.  (i  dr.). 

4  p.  M.:  Cooked  chopped  chicken,  25  gm.  (6  dr.). 

5  P.M.:  Egg. 

Sugar,  14  gm.  (3^  dr.). 

6  P.  M.:  Milk,  166  c.c.  (5I  oz.). 

Scraped  beef,  24  gm.  (6  dr.). 
Boiled  rice,  67  gm.  (2  oz.). 
Butter,  4  gm.  (i  dr.). 

7  P.  M. :  I  soft-boiled  egg. 

Total  Tenth  Day. — Eggs  (raw),  4;  cooked,  4;  milk, 
1000  c.c.  (33^  oz.) ;  sugar,  40  gm.  (i|  oz.) ;  scraped  beef, 
70  gm.  (2I  oz.) ;  boiled  rice,  200  gm.  (6|  oz.) ;  zwieback, 
40  gm.  (i|  oz.),  or  toast,  20  gm.  (5  dr.);  chicken,  50  gm. 
(if  oz.);  butter,  20  gm.  (5  dr.). 


Eleventh  Day 

7  A.  M. :  I  soft-boiled  egg. 

Milk,  250  c.c.  (8|  oz.). 
Zwieback,  10  gm.  (2I  dr.). 
Butter,  4  gm.  (i  dr.). 


GASTRIC  DIETS  43 

8  A.  M. :  Egg. 

Sugar,  13  gm.  (3  dr.). 

Scraped  beef,  20  gm.  (5  dr.). 

Boiled  rice,  75  gm.  (2I  oz.). 

Zwieback,  10  gm.  (2^  dr.). 

Butter,  6  gm.  (i^  dr.). 
II  A.  M.:  I  soft-boiled  egg. 

Milk,  250  CO.  (8|  oz.). 

Butter,  6  gm.  (i^  dr.). 

Zwieback,  10  gm.  {2^  dr.). 
I  p.  M.:  Egg. 

Sugar,  13  gm.  (3  dr.). 

Cooked  chopped  chicken,  25  gm.  (6  dr.). 

Boiled  rice,  75  gm.  (2^  oz.). 
3  p.  M. :  I  soft-boiled  egg. 

Milk,  250  c.c.  (8^  oz.). 

Scraped  beef,  20  gm.  (5  dr.). 

Boiled  rice,  75  gm.  (2I  oz.). 

Zwieback,  10  gm.  (2I  dr.). 

Butter,  6  gm.  (i|  dr.). 
5  P.M.:  Egg. 

Sugar,  14  gm.  (3I  dr.). 

Cooked  chopped  chicken,  25  gm.  (6  dr.). 

Boiled  rice,  75  gm.  (2I  oz.). 

Butter,  6  gm.  (i|  dr.). 
7  p.  M. :  I  soft-boiled  egg. 

Milk,  250  c.c.  {8^  oz.). 

Zwieback,  10  gm.  (2I  dr.). 

Butter,  6  gm.  (i|  dr.). 

Scraped  beef,  30  gm.  (i  oz.). 
Total   Eleventh   Day. — Eggs    (raw),   4;   cooked,   4; 
milk,  1000  c.c.  (33I  oz.) ;  butter,  40  gm.  (i|  oz.) ;  sugar, 


44  GASTRIC  DIETS 

40  gm.  (i^  oz.) ;  scraped  beef,  70  gm.  (2^  oz.) ;  boiled  rice, 
300  gm.  (30  oz.) ;  zwieback,  60  gm.  (2  oz.) ;  chicken,  50  gm. 
(if  oz.). 

Twelfth  Day. 

7  A.  M. :  I  soft-boiled  egg. 

Milk,  250  c.c.  (8|  oz.). 

Zwieback,  10  gm.  (2I  dr.). 

Butter,  4  gm.  (i  dr.). 
9  A.M.:  Egg. 

Sugar,  13  gm.  (3  dr.). 

Scraped  beef,  35  gm.  (i  oz.). 

Boiled  rice,  75  gm.  (2I  oz.). 

Zwieback,  10  gm.  (2^  dr.). 

Butter,  6  gm.  (i|  dr.). 
II  A.  M.:  I  soft-boiled  egg. 

Milk,  250  c.c.  (8^  oz.). 

Zwieback,  20  gm.  (5  dr.). 

Butter,  6  gm.  (i^  dr.). 
I  p.  M. :  Egg. 

Sugar,  13  gm.  (3  dr.). 

Cooked  chopped  chicken,  25  gm,  (6  dr.). 

Boiled  rice,  75  gm.  (2I  oz.). 

Zwieback,  10  gm.  (2^  dr.). 

Butter,  6  gm.  (i§  dr.). 
3  p.  M. :   I  soft-boiled  egg. 

Milk,  250  c.c.  (8f  oz.). 

Scraped  beef,  35  gm.  (i  oz.). 

Boiled  rice,  50  gm.  (if  oz.). 

Zwieback,  10  gm.  (2^  dr.). 

Butter,  6  gm.  (i|  dr.). 


GASTRIC  DIETS  4S 

5  P.M.:  Egg. 

Sugar,  14  gm.  (3I  dr.). 

Cooked  chopped  chicken,  25  gm.  (6  dr.). 

Boiled  rice,  75  gm.  (2^  oz.). 

Zwieback,  10  gm.  (2I  dr.). 

Butter,  6  gm.  (i|  dr.). 
7  p.  M. :  I  soft-boUed  egg. 

Milk,  250  c.c.  (8§  oz.). 

Zwieback,  10  gm.  (2^  dr.). 

Butter,  6  gm.  (i§  dr.). 
Total  Twelfth  Day. — Eggs  (raw),  4;  cooked,  4;  milk, 
1000  c.c.  (33^  oz.) ;  sugar,  40  gm.  (i^  oz.) ;  scraped  beef, 
70  gm.  (2I  oz.) ;  boiled  rice,  30x3  gm.  (10  oz.) ;  zwieback, 
80  gm.  (2I  oz.) ;  chicken,  50  gm.  (if  oz.) ;  butter,  40  gm. 
(i^  oz.). 

Thirteenth  Day 

7  A.  M. :  I  soft-boiled  egg. 

Milk,  142  c.c.  (4!  oz.). 

Zwieback,  10  gm.  (2I  dr.). 

Butter,  4  gm.  (i  dr.). 
9  A.M.:  Egg. 

Sugar,  13  gm.  (3  dr.). 

Milk,  142  c.c.  (4!  oz.). 

Scraped  beef,  20  gm.  (5  dr.). 

Boiled  rice,  75  gm.  (2I  oz.). 

Zwieback,  20  gm.  (5  dr.). 

Butter,  6  gm.  (i^  dr.). 
II  A.  M.:  I  soft-boUed  egg. 

Milk,  144  c.c.  (5  oz.). 

Zwieback,  10  gm.  (2^  dr.). 

Butter,  6  gm.  (i|  dr.). 


46  GASTRIC  DIETS 

I  P.  M.:  Egg. 

Sugar,  13  gm.  (3  dr.). 

Milk,  142  c.c.  (4I  oz.). 

Cooked  chopped  chicken,  25  gm.  (6  dr.). 

Boiled  rice,  75  gm.  (2^  oz.). 

Zwieback,  10  gm.  (2^  dr.). 

Butter,  6  gm.  (i|  dr.). 
3  p.  M. :   I  soft-boiled  egg. 

Milk,  144  c.c.  (5  oz.). 

Scraped  beef,  20  gm.  (5  dr.). 

Boiled  rice,  75  gm.  (2I  oz.). 

Zwieback,  10  gm.  (2^  dr.). 

Butter,  6  gm.  (i|  dr.). 
5  P.M.:  Egg. 

Sugar,  14  gm.  (3I  dr.). 

Milk,  142  c.c.  (5  oz.). 

Cooked  chopped  chicken,  25  gm.  (6  dr.). 

Boiled  rice,  75  gm.  (2I  oz.). 

Zwieback,  10  gm.  (2^  dr.). 

Butter,  6  gm.  (i|  dr.). 
7  p.  M. :   I  soft-boiled  egg. 

Milk,  144  c.c.  (5  oz.). 

Zwieback,  10  gm.  (2^  dr.). 

Butter,  6  gm.  (i|  dr.). 

Total  Thirteenth  Day. — Eggs  (raw),  4;  cooked,  4; 
milk,  1000  c.c.  (33^  oz.) ;  sugar,  40  gm.  (i|  oz.) ;  scraped 
beef,  70  gm.  (25  oz.);  boiled  rice,  300  gm.  (10  oz.); 
zwieback,  80  gm.  (2!  oz.);  chicken,  50  gm.  (if  oz.); 
butter,  40  gm.  (i|  oz.). 


GASTRIC  DIETS  47 

Fourteenth  Day 

7  A.  M. :  I  soft-boiled  egg. 

Minced  chop. 

Buttered  toast. 

Milk,  142  c.c.  (4!  oz.). 
9  A.  M. :  Boiled  rice. 

Buttered  zwieback. 

Custard. 

Milk,  142  c.c.  (4!  oz.). 
II  A.  M.:  I  soft-boiled  egg. 

Buttered  zwieback. 

Junket. 

Milk,  144  c.c.  (5  oz.). 
I  p.  M. :  Minced  chicken. 

Boiled  rice. 

Buttered  zwieback. 

Custard. 

Milk,  142  c.c.  (4!  oz.). 
3  p.  M. :  I  soft-boiled  egg. 

Cooked  scraped  beef. 

Boiled  rice. 

Buttered  tost. 

Milk,  144  c.c.  (5  oz.). 
5  p.  M. :  Minced  chicken. 

Boiled  rice. 

Buttered  zwieback. 

Custard. 

Milk,  142  c.c.  (4!  oz.). 
7  p.  M. :  I  soft-boiled  egg. 

Buttered  toast. 

Milk,  144  c.c.  (5  oz.). 
Total  Fourteenth  Day. — Eggs  (raw),  4;  cooked,  4; 


48  GASTRIC  DIETS 

milk,  looo  c.c.  (33^  oz.) ;  sugar,  40  gm.  (if  oz.) ;  scraped 
beef,  70  gm.  (2^  oz.) ;  boiled  rice,  300  gm.  (10  oz.) ;  zwie- 
back, 100  gm.  (3I  oz.) ;  butter,  40  gm.  (if  oz.)  chicken,  50 
gm.  (if  oz,).     (Recapitulation  of  Lenhartz  Diet,  p.  49.) 

Convalescent  Gastric  Diets,  No,  P 
Breakfast:  Boiled  milk  with  cocoa  or  coffee. 
Any  cereal,  strained,  with  cream. 
Soft  toast,  buttered. 
II  A.  M. :      Glass  of  milk. 

Dinner:       Puree  of  potatoes,   peas,   or   beans   with 
toast  soaked  in  it,  or  boiled  rice,  with 
milk  or  cream. 
Junket  or    custard,  or  jelly    or  tapioca 
pudding. 
4  p.  M.:        Glass  of  milk  with  beaten  egg  in  it. 
Supper:       2  soft-boiled  eggs. 
Soft  toast. 
Glass  of  milk. 
9.30  p.  M. :  Glass  of  milk,  with  beaten  egg  in  it. 

Convalescent  gastric  Diets,  No.  2* 
Breakfast:  Boiled  milk,  with  a  little  coffee  or  cocoa. 
Any  cereal,  strained,  with  cream. 
Dry  toast,  buttered. 
I  egg. 
II  a.  M.:     Glass  of  malted  milk. 
Lunch:        2  soft-boiled  or  scrambled  eggs,  or  fresh 
boiled  fish  in  place  of  eggs. 
A  little  broiled  bacon  (eating  the  fat  and 

not  the  lean.) 
Toast  and  milk. 
^  T.  C.  Janeway.  *  Ibid. 


GASTRIC  DIETS 


49 


*a  tn 


B     2, 


If 


If 


l§ 


If 


1% 


If 


Jd    >d    ?0 


h  r>  p  p  p  p  ppppppoS 

04  CM  CM  CM  O  OsCmOO\CmO        •*)      a** 

*•*        •**        ■•'        "^         o         **        '**o"*''**ooo 

O     O      O      O      N      o      OMOONnS 
N       t)       N       N      ^      N       fwNS^Oww 

^      ^      4^      4^      ^      ^      ^CMCmUU 

o    o    o    o    o    o    ooooo 
*■■■■■    » 

O      O      O      O      O      O      ONNflSr 
N       N       N       N       N       N       N^^^^ 

OOOOOOOO^  C/] 

oooooooS*  a 

NNC'^NNNNO  S> 

CM  Cm  CM  M  M  M  1-1 

8       8       8       8       8       8      8 


o  o      V,  O 

-g3;2§B 

^  -       M    N  M 


w 
o 

> 

H 

a 

H 

M 
O 

o 

M 

!2; 


B        B 


so  GASTRIC  DIETS 

Dinner:      Puree    of    potatoes,    rice,    barley,    peas, 
asparagus,  celery,  or  beans. 

Buttered  toast. 

Rare  beefsteak  broiled,  or  lamb  chop 
broiled,  roast  beef  or  lamb. 

Roast  or  broiled  chicken  or  minced  chicken, 
with  well-cooked  rice  or  a  well-baked 
potato  with  butter. 

Junket  or  custard,  jelly  or  tapioca  pud- 
ding. 
10.30  P.  M. :  Glass  of  milk  with  lime-water. 

Comments  on  Gastric  Diets 

Stomach. — ^The  reputation  of  the  Lenhartz  diet  in  the 
treatment  of  peptic  ulcer  is  too  well  established  to  need 
comment;  one  or  two  things  only  might  be  said  in  regard 
to  its  use.  In  the  first  place,  in  this  country  there  is  a 
deep-rooted  and  reasonable  prejudice  against  the  use  of 
any  hard  substance  in  the  diet  of  gastric  ulcer,  either 
acute  or  chronic,  and  wherever  this  occurs  in  the  Len- 
hartz diet  it  would  seem  wise  to  substitute  some  soft 
substance — e.  g.,  soaked  toast  or  bread  in  place  of  dry 
zwieback.  Then,  too,  the  rapidity  with  which  this 
routine  can  be  carried  out  varies  with  different  persons, 
and  it  is  often  necessary  to  go  more  slowly  than  the 
regular  schedule. 

Before  the  introduction  of  this  diet,  it  had  been 
thought  necessary  to  starve,  or  practically  starve, 
patients  with  acute  peptic  ulcer  for  a  week  or  two, 


GASTRIC  DIETS  51 

except  for  uncertain  attempts  at  rectal  feeding.  Len- 
hartz  went  to  the  other  extreme,  and  taught  that  one 
could  begin  at  once  with  advantage  to  feed  these  cases, 
even  in  the  face  of  hemorrhage,  feeling  that  patients 
would  do  better  if  given  food,  as  starvation  makes  it 
more  difficult  for  them  to  further  the  process  of  repair. 
His  idea  was  to  furnish  a  highly  albuminous,  bland 
food  in  gradually  increasing  amounts,  and  during  the 
feeding  hours  always  keeping  something  in  the  stomach 
for  the  hydrochloric  acid  to  combine  with,  which  would 
otherwise  keep  the  ulcerated  surface  irritated,  i.  e.,  if 
free.  A  period  of  twelve  hours'  rest  is  given  the  stom- 
ach. A  convenient  method  for  using  the  Lenhartz  diet 
is  to  have  each  day's  diet  written  on  a  card  which  is 
hung  with  the  patient's  chart.  The  cards  are  changed 
every  day  as  the  ration  is  increased. 

To  many  internists,  however,  it  also  seems  a  wise 
measure  to  give  the  stomach  absolute  rest  for  from 
forty-eight  to  seventy-two  hours  or  even  longer  (up  to 
one  week),  particularly  in  acute  hemorrhagic  cases,  be- 
fore begiiming  any  mode  of  gastric  feeding,  during  which 
time,  or,  at  all  events,  for  the  first  two  or  three  days, 
normal  salt  solution  by  rectmn  will  furnish  all  the  fluids 
necessary.  If  it  seems  best  to  rest  the  stomach  longer 
than  two  days,  it  is  usually  best  to  furnish  some  food  by 
rectal  alimentation.  As  usually  done,  with  a  thick  mix- 
ture of  eggs,  milk,  flour,  etc.,  this  form  of  feeding  is  abso- 
lutely useless,  and,  as  proved  by  numerous  experiments 


52  GASTRIC  DIETS 

of  the  author  and  others,  ahnost  nothing  is  absorbed. 
If,  however,  milk  is  given  by  rectum,  which  has  been 
first  sterihzed  and  then  fully  peptonized  for  two  hours 
or  more  or  until  it  becomes  watery,  thin,  and  of  a  green- 
ish-yellow color,  and  then  scalded  to  kill  the  bacteria, 
which,  of  course,  increase  during  the  two  hours  or  more 
at  incubation  temperature,  a  certain  amount  of  pro- 
tein and  calories  can  be  furnished  to  the  organism. 
To  be  sure,  this  is  entirely  insufficient,  but  still 
enough  to  help  maintain  strength.  This  milk  can  be 
further  reinforced  by  a  glucose  or  maltose  addition, 
although  care  must  be  taken  that  its  presence  does 
not  increase  the  rectal  peristalsis  and  result  in  failure 
to  retain  the  enemata.  The  author's  usual  dietetic 
treatment  of  these  cases  is  to  starve  for  forty-eight 
hours,  giving  saline  by  rectum,  8  to  i6  oz.  every  four 
to  six  hours,  with  the  foot  of  the  bed  elevated.  Then 
begin  with  rectal  feeding  of  fully  peptonized  milk,  8 
to  1 6  oz.  every  four  to  six  hours,  depending  on  the  abil- 
ity of  the  patient  to  hold  it.  Given  through  a  rectal 
tube  inserted  fairly  high,  with  the  foot  of  the  bed  well 
raised  and  kept  so  for  at  least  an  hour  after  feedings, 
there  is  seldom  any  difficulty  in  the  patient's  retaining  it. 
To  each  rectal  feeding  may  be  added  from  i  to  i|  oz. 
of  glucose  or  maltose,  first  thoroughly  dissolved  in  a 
little  hot  water.  This  rectal  feeding  is  kept  up  for 
several  days,  or  until  the  mouth  feedings,  which  can 
begin  from  the  third  to  the  sixth  day,  are  more  nearly 


GASTRIC  DIETS  S3 

adequate  to  supply  the  needed  nourishment.  After 
the  seventh  day  of  the  Lenhartz  diet,  it  is  often  best  to 
increase  it  every  other  day  instead  of  every  day,  or 
in  some  cases  to  work  toward  the  use  of  the  Conva- 
lescent Gastric  Diets  Nos.  i  and  2.  The  lower  colon 
should  be  washed  out  once  daily  with  saline  in  order 
to  keep  the  mucous  membrane  in  a  clean  condition. 
Under  certain  circumstances  rectal  feeding  is  impracti- 
cable; in  these  cases,  particularly  if  mild,  or  the  patient 
robust,  it  may  be  dispensed  with. 

The  dietetic  treatment  of  ambulatory  cases  of  chronic 
gastric  or  duodenal  ulceration  has  a  very  distinct  place 
in  therapeutics,  for  many  of  these  cases  are  apparently 
well,  except  for  the  characteristic  epigastric  pain  which 
comes  on  at  varying  times  after  meals,  and  refuse  the 
suggestion  of  taking  an  ulcer  "cure,"  as  they  will  not 
give  the  necessary  time.  These  cases  are  often  helped 
surprisingly  if  they  are  put  on  a  diet  for  two  full  weeks 
of  milk,  soft-boiled  eggs  (one  to  two  minutes),  and  cream, 
given  somewhat  as  follows: 

At  8  A.  M.,  I  p.  M.,  and  7  p.  m.:  2  glasses  of  milk  (and 
cream) ;  2  soft-boiled  eggs. 

At  II  A.  M.,  4  p.  M.,  and  10  p.  m.:  i|  glasses  of  milk 
and  cream. 

This  gives:  Milk,  2040  c.c.  (68  oz.);  cream,  480  c.c. 
(16  oz.);  6  eggs. 

Protein,  102  gm.  (3^  oz.);  fat,  200  gm.  (6f  oz.); 
carbohydrate,  123  gm.  (4  oz.);  calories,  2200. 


54  GASTRIC  DIETS 

At  the  end  of  ten  days,  if  this  has  been  well  taken, 
and  there  has  been  no  pain  for  several  days,  the  patient 
may  be  allowed  well  cooked  farina  twice  a  day  (i  or  2 
tablespoonfuls). 

At  the  end  of  the  two  weeks  other  soft  foods  are 
gradually  added,  such  as  any  thin  cereal,  soft  toast, 
custard,  finely  cut  white  meat  of  boiled  chicken,  boiled 
cod  or  halibut,  then  baked  potatoes,  chopped  steak,  and 
anything  which  is  soft  and  without  acid  or  excess  of  salt. 

Many  cases  will  go  for  months  or  years  after  such  a 
course  of  diet  without  a  return  of  symptoms.  These 
cases  should  never  eat  hard  or  irritating  foods,  such  as 
berries  with  seeds,  figs,  hard  toast,  raw  vegetables,  etc. ; 
acids  and  condiments  as  well  should  be  avoided. 

The  convalescent  gastric  diets  will  be  found  of  use 
after  acute  gastritis  or  following  a  Lenhartz  ulcer  cure, 
for  it  is  wise  to  insist  that  for  some  weeks  the  patient 
shall  put  into  the  stomach  only  the  softest  foods  possible. 

The  dietary  treatment  of  duodenal  ulcer  is  quite  the 
same  as  that  for  gastric,  and  it  is  not  always  possible 
to  differentiate  between  them  clinically.^ 

^In  connection  with  the  dietary  treatment  of  these  cases  of  chronic 
ulcer  of  the  stomach  or  duodenum,  the  use  of  subnitrate  of  bismuth  in 
dram  doses,  with  2  ounces  of  water  on  early  morning  fasting  stom- 
ach, is  almost  always  of  the  greatest  assistance  in  stopping  the  pain. 
This  is  often  advantageously  preceded  by  washing  the  stomach  clean, 
then  with  silver  nitrate  solution,  beginning  i :  6000  and  increasing  daily 
vmtil  1 :  2000  is  used,  wash  again  until  all  trace  of  silver  disappears. 
This  can  be  continued  daily  for  seven  to  ten  days,  then  every  other 
day,  twice  or  once  a  week,  xmtil  all  symptoms  are  gone. 


GASTRIC  HYPERACIDITY 

The  dietetic  treatment  of  a  hyperacid  gastric  condition, 
of  course,  depends  largely  upon  the  underlying  cause  of 
the  hyperacidity;  thus,  if  it  is  due  to  ulcer  of  the  stomach 
or  duodenum,  the  proper  diet  for  these  conditions  is 
indicated.  There  are  cases,  however,  in  which  the  hyper- 
acidity is  a  S3nnptom  of  indefinite  and  apparently  of 
mild  origin  in  which  a  modified  diet  is  of  use. 

The  principle  upon  which  this  diet  is  constructed  is 
based  upon  the  fact  that  food  which  is  chemically, 
thermally,  or  mechanically  irritating,  or  which  stays  a 
long  time  in  the  stomach,  is  almost  sure  to  increase  the 
hyperacidity.  Hence,  these  things  should  be  omitted 
from  the  diet  and  only  bland  foods  used..  The  other 
underlying  principle  of  the  diet  is  that  it  should  be  of 
a  high  protein  value,  in  order  to  offer  a  large  amount  of 
this  element  to  combine  with  the  free  hydrochloric 
acid  which  is  in  excess  in  this  condition.    ' 

The  protein  should  preferably  be  of  the  least  stimulat- 
ing variety,  hence  meat  is  allowed  only  in  small  amoimt. 
The  best  kind  of  animal  protein  being  that  contained  in 
eggs,  milk,  and  boiled  fish. 


55 


$6  GASTRIC  HYPERACIDITY 

Diet  Useful  in  Gastric  Hyperacidity 

May  take: 

Raw  oysters. 

Soups:  Cream  or  puree  (except  tomato). 

Fish:  Fresh  cod,  halibut,  bass,  boiled  with  cream 
sauce  or  broiled. 

Meat:  Beef  well  done  (without  gristle,  fat,  or  gravy), 
chicken,  turkey,  guinea-hen,  lamb  (without  fat), 
once  daily. 

Vegetables:  All  soft-boiled  green  vegetables,  except 
cabbage,  cauliflower,  brussel  sprouts,  or  turnips. 
Baked  white  potato  may  be  used  moderately. 
Rice  or  macaroni. 

Cheese:  Any  mild  variety,  but  better  without  this  at 
first. 

Desserts:  Cream  and  egg  desserts  of  all  sorts,  e.  g., 
blanc  mange,  Bavarian  cream,  floating  island, 
cup  custard,  junket,  soft,,.rtCr^r  bread  puddings. 
Gelatin  desserts  m^f^e  with  little  flavoring.  Very 
little  sugar  used  in  all  desserts.  Fruit,  none,  except 
when  constipation  is  a  marked  feature,  then  stewed 
soft  fruits  may  be  taken  in  good  amount,  but  must 
be  cooked  with  very  little  sugar  and  are  best  taken 
with  or  after  a  meal,  never  before.  Cream  may 
usually  be  freely  used. 

Bread:  Toast,  stale  bread,  roll.  (Fresh  butter  or 
salt  butter  freshened  by  working  it  over  in  fresh 
water.) 

Drinks:  Weak  tea,  cocoa,  water,  and  milk. 

Cereals:  Fine-grained  varieties,  well  cooked. 

Eggs:  In  all  forms  except  fried. 


GASTRIC  HYPERACIDITY  57 

Foods  to  he  avoided: 

All  sour,  spiced,  or  peppery  foods,  condiments,  salt 

foods,  chow-chow,  etc.    Sweets,  fried  foods. 
Very  hot  or  very  cold  food  or  drinks. 
Rough  hard  substances,  such  as  seeds,  skins  of  fruit 

or  vegetables,  com,  uncooked  vegetables. 
CoJBfee,  wines,  Kquors,  beer. 
Hot  breads,  pies,  cakes,  sjniips,  etc. 


i 


DIABETIC  DIETS 

Standard  Strict  Diet* 

Breakfast:  2  eggs. 

Ham,  90  gm.  (3  oz.). 

Coffee  with  45  gm.  (i§  oz.)  cream. 

Butter,  15  gm.  (|  oz.)  on  the  biscuit  during 
the  test  period;  cooked  with  the  eggs  if 
no  biscuit  or  bread  is  taken. 
Luncheon:  Meat  (steak  or  chops),  120  gm.  (j  pound). 

Green  vegetables  from  list,  2  table- 
spoonfuls. 

White  wine,  2  claret  glasses  (6  oz.),  or 
whisky  or  brandy,  2  tablespoonfuls 
(i  oz.). 

Butter,   15  gm.   (|  oz.),  with  the  green 
vegetable,  if   no   buscuit  or   bread   is 
taken. 
Afternoon  tea  with  15  gm.  (|  oz.)  of  cream. 
Dinner:       Any  clear  soup. 

Fish,  90  gm.  (3  oz.). 

Meat  (beef,  mutton,  turkey,  or  chicken), 
120  gm.  (j  pound). 

Green  vegetables  from  list,  2  tablespoon- 
fuls. 

Salad  with  15  gm.  (^  oz.)  of  oil  in  the 
dressing. 

*  T.  C.  Janeway  in  Musser  and  Kelly,  Practical  Therapeutics. 
58 


DIABETIC  DIETS  $g 

Cream  cheese,  30  gm.  (i  oz.). 
White  wine,  2  claret  glasses  (6  oz.),  or 
whisky    or    brandy,    2    tablespoonfuls 
(i  oz.). 
Demi-tasse  of  coffee. 

Butter,  30  gm.  (i  oz.)  on  the  fish,  meat,  and 
green  vegetables  if  no  bread  or  biscuit 
is  taken. 
Bedtime:   Bouillon  with  i  raw  egg. 
Protein,  112  gm.  (3I  oz.);  nitrogen,  18  gm.  (4I  dr.); 
fats,  160  gm.  (5^  oz.);  calories,  2200;  omitting  ham, 
protein,  94  gm.  (3  oz.);  nitrogen,  15  gm.  (3!  dr.). 

For  convenience  in  determining  the  carbohydrate 
tolerance  the  following  biscuits  may  be  used,  as  the  per- 
centage of  carbohydrate  is  practically  constant. 

Huntley  &  Palmer  breakfast  biscuit  contains  5  gm. 
carbohydrate.  Uneeda  biscuit  contains  4.6  gm.  carbo- 
hydrate (Mosenthal). 

Standard  Diet  vith  Restricted  Protein* 

Breakfast:  2  eggs. 

Bacon,  15  gm.  (§  oz.). 

Coffee,  with  45  gm.  (i|  oz.)  of  cream. 

Butter,  20  gm.  (f  oz.). 
Luncheon:  i  egg. 

Bacon,  15  gm.  (§  oz.). 

Meat    (lamb-chops,  ham,  or   beefsteak), 
60  gm.  (2  oz.). 

Salad,  with  15  gm.  (|  oz.)  of  oil  in  the 
dressing. 

^  T.  C.  Janeway  in  Musser  and  Kelly,  Practical  Therapeutics. 


6o  DIABETIC  DIETS 

White   wine,    2    claret   glasses,    180   c.c. 
(6  oz.),  or  whisky  or  brandy,  2  table- 
fuls,  30  c.c.  (i  oz.). 
Butter,  40  gm.  (if  oz.). 
Afternoon  tea  with  15  gm.  (f  oz.)  of  cream. 
Dinner:       Any  clear  soup. 

Meat  (roast  pork,  beef,  mutton,  turkey, 

or  lamb  chops),  90  gm.  (3  oz.). 
Vegetables  from  list,  2  tablespoonfuls. 
Salad  with  15  gm.  (|  oz.)  of  oil  in  the 

dressing. 
Cream  cheese,  30  gm.  (i  oz.). 
White   wine,    2    claret   glasses,    180   c.c. 
(60Z.),  or  whisky  or  brandy,  2  table- 
spoonfuls,  30  c.c.  (i  oz.). 
Demi-tasse  of  coffee. 
Butter,  30  gm.  (i  oz.). 
Bedtime:    Bouillon  with  i  raw  egg. 
Protein,  62  gm.  (2  oz.) ;  nitrogen,  10  gm.  (2  dr.) ;  fat, 
180  gm.  (6  oz.);  total  calories  equal  2500.     Omitting 
30  gm.  of  butter  and  |  oz.  of  bacon,  calories  equal 

2250. 

Green  Days^ 

Breakfast:  i  egg,  boiled  or  poached. 

Cupful  of  black  coffee. 
Dinner:       Spinach,  with  hard-boiled  egg. 
Bacon,  15  gm.  (^  oz.). 
Salad  with  15  gm.  (|  oz.)  of  oil. 
White  wine,  j  liter  (4  oz.),  or  whisky  or 
brandy  30  c.c.  (i  oz.). 
4.30  p.  M. :  Cup  of  beef-tea  or  chicken  broth. 
1  T.  C.  Janeway  in  Musser  and  Kelly,  Practical  Therapeutics. 


DIABETIC  DIETS  6l 

Supper:       i  egg,  scrambled  with  tomato  and  a  little 
butter. 
Bacon,  15  gm.  (^  oz.). 
Cabbage,  cauliflower,  sauerkraut,  string- 
beans,  or  asparagus. 
White  wine,  J  Hter  (4  oz.),  or  whisky  or 
brandy,  30  c.c.  (i  oz.). 
Sodium  bicarbonate,  15  to  30  gm.  (|-i  oz.)  in  the 
twenty-four  hours.     Protein,  32  gm.  (i  oz.);  nitrogen, 
5  gm.  (i  dr.);  carbohydrate,  about  5  gm.  (i  dr.);  fat, 
67  gm.  (2  oz.);  calories,  575. 

General  Diabetic  Diet-list  * 

May  take  freely: 

Soups:  All  meat  soups  and  broths.  May  add  vege- 
tables allowed;  egg  or  cheese. 

Meats:  All  fresh,  smoked,  and  cured  meats  (except 
liver),  poultry  and  game,  without  sauces  or  gravies 
containing  flour,  pate  de  foies  gras. 

Fish:  All  kinds,  except  oysters,  clams,  and  scallops, 
cooked  without  bread-crumbs  or  meal;  all  dried, 
salted,  smoked  or  pickled  fish. 

Eggs:  Prepared  in  any  way  without  flour. 

Fats:  Butter,  lard,  suet,  olive  oil,  or  other  fats. 

Cheeses:  All  kinds,  especially  cream,  Swiss,  English, 
and  pineapple  cheese. 

Vegetables  and  Salads:  Asparagus,  beet  greens,  Brus- 
sels sprouts,  cabbage,  cauliflower,  celery,  chicory, 
cresses,  cucumbers,  egg-plant,  endive,  kohlrabi, 
leeks,  lettuce,  okra,  pumpkin,  radishes,  rhubarb, 

^  T.  C.  Janeway  in  Musser  and  Kelly,  Practical  Therapeutics. 


62  DIABETIC  DIETS 

salsify,  sauerkraut,  spinach,  string-beans,  tomatoes, 
vegetable  marrow. 

Pickles  made  from  the  above  vegetables,  unsweetened; 
ripe  olives. 

Fungi:  Mushrooms  and  trujBes. 

Cream:  Not  over  90  c.c.  (3  oz.)  a  day. 

Condiments:  Salt,  pepper,  cayenne,  paprika,  curry, 
cinnamon,  cloves,  EngHsh  mustard,  nutmeg,  cara- 
way, capers,  vinegar,  and  the  piquant  sauces  in 
small  quantities  unless  specially  forbidden. 

Desserts:  Jellies  made  from  gelatin;  custards  and  ice- 
cream made  with  eggs  and  cream;  all  sweetened  with 
saccharin  and  flavored  with  vanilla;  coffee  or  brandy. 

Nuts:  Butternuts. 

Beverages:  Tea  or  coffee,  sweetened  with  saccharin 
and  with  the  portion  of  cream  allowed.  Whisky, 
brandy,  nmi,  and  other  distilled  liquors,  up  to  3  oz. 
a  day.  Light  Rhine  or  Moselle  wine,  claret,  or 
Burgundy,  up  to  16  oz.  a  day  (i  pint).  Mineral 
waters  of  aU  kinds.  Lemonade  in  small  quantity, 
sweetened  with  saccharin. 

Articles  Prohibited,  Except  as  Prescribed  in  the  Acces- 
sory Diet: 

Sugars  and  sweets  of  every  kind. 

Pastry,  puddings,  preserves,  cake,  and  ice-cream. 

Bread  and  biscuits  of  all  kinds,  toast,  crackers,  and 

griddle  cakes. 
Cereals,  such  as  rice,  oatmeal,  sago,  hominy,  tapioca, 

and  barley. 
Macaroni,  potatoes,  carrots,  parsnips,  beans,  peas, 

beets,  green  corn,  and  turnips. 


DIABETIC  DIETS  63 

Fruit  of  all  kinds,  fresh  or  dried. 

Soups,  sauces,  or  gravies  thickened  with  flour  or  meal, 

or  made  with  milk. 
Beer,  ale,  porter,  all  sweet  wines,  sherry  or  port  wine, 

sparkling  wines,  cider,  and  liquors. 
Milk,  chocolate,  or  cocoa. 
All  sweet  drinks  and  soda-water. 

Oatmeal  Days* 

Porridge  made  from  oatmeal,  250  gm.  (8  oz.),  with 
butter,  250  gm.  (8  oz.) ;  salt  and  pepper  to  taste. 

Black  coffee,  light  white  wine,  I  Hter  (8  oz.),  or  cognac, 
60  c.c.  (2  oz.). 

The  whites  of  6  eggs  may  be  added  to  the  porridge  if 
desired. 

Nitrogen.  Carbohydrate. 

Gm.  Gm.  Calories. 

Oatmeal 6.2                            170  1025 

Butter _o4                            ...  i975 

6.6=42  gm.  protein.  3000 

Alcohol  (40  gm.) 210 

6  egg  whites 3.6  9^ 

10.2  =63  gm.  protein.  3300 

The  entire  diet  consists  of:  Protein,  63  gm.  (2  oz.); 
nitrogen,  16.8  gm.  (i  oz.);  carbohydrate,  170  gm.  (sf 
oz.);  fat,  212  gm.  (7  oz.);  calories,  3300. 

Comments  on  Diabetic  Diet 

Such  an  enormous  amount  has  already  been  written 

on  the  dietetic  treatment  of  diabetes  meUitus  that  one 

hesitates  about  going  into  the  details  and  indications. 

1  T.  C.  Janeway  in  Musser  and  Kelly,  Practical  Therapeutics. 


64  DIABETIC  DIETS 

The  principles  underlying  the  subject  may,  however, 
be  stated  here  with  propriety,  and  general  directions 
given  for  the  use  of  the  diabetic  diets  and  the  table  of 
carbohydrate  equivalents,  which  will  be  found  to  be  a 
great  help  in  arranging  a  varied  and,  therefore,  more 
palatable  diet  for  patients  with  this  disease. 

Whatever  may  be  the  underlying  organic  lesion  in  a 
particular  case,  the  result  is  the  same;  namely,  that  the 
power  of  properly  metabolizing  carbohydrates  is  im- 
paired to  a  greater  or  less  degree. 

The  object  sought  in  dietetic  treatment  is  to  find  the 
limit  of  the  individual's  carbohydrate  tolerance,  and 
then,  by  a  slow  system  of  gradually  increasing  the  amount 
of  starch  or  sugar,  re-educate  the  system  in  its  lost 
power  to  as  high  a  degree  as  possible,  always  remem- 
bering that  these  cases  can  never  go  back  to  a  free 
or  unlimited  use  of  carbohydrates. 

The  exact  form  which  the  dietetic  treatment  of 
diabetes  should  take  must  depend  on  the  severity  of  the 
case,  and,  for  the  sake  of  clearness  on  this  point,  we  may 
arbitrarily  divide  the  cases  into: 

(i)  Mild,  without  acidosis. 

(2)  Moderately  severe,  without  acidosis  or  with 
moderate  acidosis. 

(3)  Severe,  with  marked  acidosis. 

In  (i)  and  (2)  the  first  step  is  to  find  the  individual's 
capacity  for  metabolizing  carbohydrates,  which  is  done 
as  follows: 


DIABETIC  DIETS  65 

A  gradual  reduction  in  starch  and  sugar  in  the  diet  is 
made  each  day,  using  less,  until,  at  the  end  of  five  to 
seven  days,  the  patient  is  taking  none  of  either.  If,  at 
this  point,  the  patient  is  still  excreting  sugar  in  the 
twenty-four-hour  urine  (and  twenty-four-hour  specimens 
are  necessary  to  an  accurate  diagnosis  of  the  condition, 
and  to  successful  treatment  in  the  early  part  of  it  at 
least),  he  should  be  put  on  the  diet  with  restricted  pro- 
tein (for  subsequent  steps,  see  p.  67).  If,  however,  the 
urine  is  sugar-free  after  one  or  two  days  of  carbohydrate- 
free  diet,  or  before  that  point  is  reached,  the  patient  is 
allowed  the  standard  diet  with  100  gm.  (3I  oz.)  of  white 
bread  divided  between  the  three  meals.  The  second 
twenty-four-hour  specimen  is  then  examined,  and,  if 
no  sugar  is  present,  increase  the  allowance  of  white 
bread  by  j  to  |  ounce  each  day  until  sugar  just  shows  in 
the  urine.  The  last  point  at  which  the  urine  fails 
to  show  sugar  represents  that  patient's  carbohydrate 
tolerance. 

The  standard  diet  plus  one-half  of  the  carbohydrate 
tolerance  is  the  diet  this  patient  should  be  put  on;  e.  g., 
if  the  point  of  tolerance  is  60  gm.  (2  oz.)  of  white  bread, 
then  30  gm.  (i  oz.)  is  all  the  patient  should  be  allowed, 
divided  between  the  three  meals.  It  is  just  here  that 
the  table  of  carbohydrate  equivalents  is  of  the  greatest 
use,  as  it  permits  the  use  of  foods  more  bulky  than 
bread,  but  of  relatively  less  carbohydrate  value  (p.  84). 

The  practical  application  in  the  use  of  this  table  in 


66 


DIABETIC  DIETS 


the  case  taken  as  an  example,  with  30  gm.  (i  oz.)  as  the 
amount  of  carbohydrates  to  be  given,  is  as  follows: 

Example  No.  i 
(If  tolerance  is  30  gm.  white  bread.) 

7.5    gm.  white  bread. 
7-5 


Proto  puflf  No.  I. . .  45  gm 

Potato 22 

Oatmeal 40 

Beets 33 

Peaches 25 

~^5 


=  7-5 

=  3-75 

=  3-75 

=  30.00 


Example  No.  2 

(If  tolerance  is  45  gm.  white  bread.) 

Potato 22  gm.  =    7.5  gm.  white  bread. 

Oatmeal 40 

Com  bread 20 

Carrots 65 

Orange 40 


187 


=  7-5 
=  15.0 

=  7-5 
=  ^7:5 
=  45 -o 


That  is,  we  can  give  a  varied  carbohydrate  diet  with 
a  bulk  of  165  gm.  of  food  worth  just  30  gm.  of  white 
bread,  which  is  our  allowance,  or  in  the  second  example, 
187  gm.  mixed  carbohydrates  equals  45  gm.  white  bread. 

This  is  sufficient  for  an  example,  as  the  practical  ap- 
plication to  each  case  is  simple  and  only  a  matter  of 
detail  and  a  little  practice. 

This  means,  of  course,  that  the  carbohydrates  must 
be  weighed,  and  at  the  outset  it  must  be  understood 


DIABETIC  DIETS  67 

that  this  is  the  only  satisfactory  way  to  arrive  at  an 
accurate  conclusion  as  to  what  constitutes  the  individ- 
ual's carbohydrate  tolerance  and  the  only  way  to  use 
the  diet  successfully.  Of  course,  later  the  eye  becomes 
well  trained  to  judge  amounts,  and  the  scales  may  be 
dispensed  with,  (von  Noorden,  however,  insists  that 
patients  must  always  live  by  the  scale.  A  difficult 
thing  to  obtain  in  America.) 

The  reason  that  it  is  necessary  to  allow  only  one-half 
the  amount  of  the  carbohydrate  tolerance  is  because, 
while  the  urine  becomes  sugar  free  on  the  full  amount 
of  the  tolerance,  the  blood  does  not  always,  and,  in 
order  to  reduce  the  sugar  content  of  the  blood  to  normal 
or  as  nearly  as  may  be,  the  lessened  amount  of  carbo- 
hydrate only  is  allowed.  No  increase  should  be  made 
in  the  allowance  until  from  one  to  three  months,  de- 
pending upon  the  severity  of  the  disease,  unless,  of 
course,  an  acidosis  should  develop,  which  would  require 
the  use  of  the  diet  as  outUned  for  the  oatmeal  days. 
The  increase  must  be  made  gradually,  the  object  being 
to  allow  little  by  little  more  carbohydrate,  but  not 
enough  to  have  it  show  in  the  urine. 

Should  the  urine  not  become  sugar  free  on  the  standard 
diet  without  carbohydrates,  the  standard  diet,  with 
restricted  protein,  should  be  used.  If  this  results  in  a 
sugar-free  urine,  then,  after  a  short  time,  the  full  standard 
diet  can  be  again  tried,  for  often  the  restricted  protein 
will  make  it  possible  for  the  organism  to  take  more  pro- 


68  DIABETIC  DIETS 

tein  than  at  first  without  the  appearance  of  sugar  in  the 
urine.  From  this  point  one  proceeds  as  in  the  first  in- 
stance. 

In  the  severe  cases,  with  more  or  less  marked  acidosis, 
it  is  best  to  put  these  patients  at  once  on  the  oatmeal 
diet,  and  keep  them  on  it  from  two  to  ten  days,  regard- 
less of  the  sugar  in  the  urine,  giving  them,  at  the  same 
time,  large  doses  of  bicarbonate  of  soda  in  the  attempt 
to  render  the  urine  alkaline,  a  thing  always  to  be  desired 
and  tried  for  in  these  cases.  Should  the  acidosis  grow 
distinctly  less,  but  the  sugar  still  be  considerable,  the 
patients  are  usually  benefited  by  two  days  on  the  green 
diet,  "green  days"  as  they  are  called.  One  goes  from 
that  to  the  standard  diet,  with  restricted  protein,  if  the 
lessened  degree  of  acidosis  will  permit,  and  from  there 
to  the  full  standard  diet,  if  possible,  after  a  few  days. 
If,  however,  the  acidosis  increases  in  the  "green  days," 
one  must  return  to  the  oatmeal  diet  again  until  that 
danger  is  past. 

Oftentimes  a  series  of  diets  in  succession  are  valuable, 
and  von  Noorden's  routine  in  a  severe  case  is  two  days 
restricted  protein  diet,  two  days  green  diet,  three  days 
oatmeal  diet. 

Often  a  patient  becomes  sugar  free  on  this  plan  even 
while  on  the  oatmeal,  and  the  organic  acids  drop  down 
very  soon.  These  seven  days  constitute  a  "set."  We 
then  go  back  to  the  diet  with  restricted  protein.  If 
sugar  appears  again,  repeat  the  "set" — by  this  means 


DIABETIC  DIETS  69 

one  can  often  get  a  patient  so  they,  can  again  take  a 
Kttle  carbohydrate  and  gradually  increase  it,  always 
aiming  to  keep  below  the  point  of  actual  carbohydrate 
tolerance. 

One  other  indication  for  the  use  of  the  oatmeal  days 
in  when  in  the  course  of  the  disease  the  patient's  stom- 
ach or  bowels  become  upset,  nausea,  vomiting,  or  diar- 
rhea ensuing. 

Wright's  diabetic  milk  fills  a  long  felt  want  in  the 
treatment  of  diabetes,  as  the  loss  of  milk  from  the  diet 
is  one  of  the  most  difficult  features  of  the  restricted  diet 
to  overcome.  This  milk  tastes  surprisingly  like  the 
fresh  milk  from  which  it  is  prepared,  and,  as  the  analysis 
shows,  contains  an  almost  negligible  amount  of  carbo- 
hydrate.   (See  Special  Recipes.) 

Note. — When  it  is  found  inconvenient  to  prepare  this 
milk  at  home,  any  good  milk  laboratory  will  make  it  up, 
or  a  similar  milk  may  be  purchased  direct  from  D. 
Whiting  &  Sons,  570  Rutherford  Avenue,  Boston,  Mass. 


ANTICONSTIPATION  DIET* 


6  A.  M.: 

Breakfast: 

lO  A.  M.: 
Dinner: 


4  p.  M. : 
Supper: 

Bedtime: 


Fruit,  stewed  or  fresh. 

1 1  glasses  of  hot  water. 

Oatmeal,  molasses,  cofifee,  bran  biscuits. 

1  egg,  baked  apple  or  prunes,  butter. 

2  glasses  of  water. 

Soup,  meat  or  fish,  all  vegetables,  salad 
and  oil,  brown  bread  and  butter,  any 
dessert,  fruit. 

2  glasses  of  water. 

Fruit,  cereal,  brown  bread  or  bran  biscuits 
and  butter,  molasses. 

Dried  figs,  prunes  or  dates,  i  glass  of  water. 


Approximate  Food  Valiie  to  he  Given 

Protein.  Carbohydrate.  Fat.         Calories. 

Men 70  gm.  (2J  oz.).     300  gm.  (10   oz.).     80  gm.  (2I  oz.).     2200 

Women.. 60  gm.  (2    oz.).     250  gm.  (  8|  oz.).     70  gm.  (2J  oz.).     1800 


Comments  on  Anticonstipation  Diet 
This  can  be  greatly  modified  in  detail  according  to 
the  patient's  financial  circumstances.  One  great  under- 
lying trouble  with  most  people  who  have  atonic  con- 
stipation (which  constitutes  by  far  the  most  common 
type)  is  that  the  colon  and  rectum  need  stimulation  by 


Modified  from  Vanderbilt  Clinic  diet  lists. 


70 


ANTICONSTIPATION  DIET  71 

a  larger  food  residue  than  the  individual  normally  con- 
sumes, so  that  in  general  it  may  be  said  that  these  cases 
need  fruits,  cooked  or  raw,  and  green  vegetables  in 
double  or  treble  the  amount  the  normal  individual  does. 
It  is  only  by  constant  effort  and  encouragement  that 
patients  can  be  brought  to  do  this,  as  they  feel  they  are 
eating  too  much  food.  This  prejudice  can  be  removed 
when  they  are  told  of  the  really  slight  food  value  of  these 
articles  of  diet,  and  that  they  are  mainly  valuable  on 
accoimt  of  their  bulk. 


LOW  CALCIUM  DIET 

Boiled  meat 250  gm 

Bread 100  gm 

Fish 100  gm 

Potatoes icxD  gm 

Apple 100  gm 

Sugar 50  gm 

Butter 50  gm 

Tea  (with  cream) 100  gm 

Calcium  content,  0.315  gm. 


(8^  oz.) 
(si  0Z-) 
(33  oz.) 
(33  oz.) 
(33  oz.) 
(if  oz.) 
(if  oz.) 
isl  oz.) 


Protein,  80  gm.  (if  oz.) ;  fat,  100  gm.  (3I  oz.) ;  carbo- 
hydrate, 145  gm.  (5  ozf.);  calories,  2000. 

Comments  on  Low  Calcium  Diet 
This  was  designed  by  Dr.  C.  G.  L.  Wolf,  of  the  Cornell 
Medical  School,  at  the  suggestion  of  my  colleague, 
Dr.  David  Bovaird,  Jr.,  who  conceived  the  idea  that 
cases  of  chronic  deforming  arthritis  might  be  greatly 
benefited  by  reducing  the  calcium  intake,  on  the  theory 
that  the  disease  is  due  to  a  disturbed  calcium  metabolism. 
This  has  been  used  in  a  number  of  cases,  both  at  the 
Presbyterian  and  Lincoln  Hospitals,  New  York,  and, 
while  it  has  not  resulted  in  any  cures,  some  of  the 
patients  have  been  greatly  relieved  of  their  pain  while 
on  the  diet.    Its  monotony  is  its  worst  feature,  and  one 

72 


LOW  CALCIUM  DIET  73 

can  seldom  get  patients  to  continue  its  use  for  long  at  a 
time.  Theoretically,  tetany  might  seem  a  possible  con- 
sequence of  withdrawing  the  calcium  from  the  diet,  but 
in  one  case  in  which  Bovaird  used  this  diet  for  many 
months  there  was  no  evidence  of  this. 

The  diet,  moreover,  is  of  scientific  value  to  anyone 
desiring  to  study  calcium  metaboUsm. 

The  fixed  nitrogen,  calcium,  magnesium  diet  has 
been  used  exclusively  for  research  work,  and  is  an  ac- 
curate analysis  of  the  food  stuffs  composing  the  diet 
in  these  three  particulars. 

FIXED  NITROGEN,  CALCIUM,  MAGNESIUM  DIET 
(VOGEL.) 

{Twenty-four-hour  Amount) 

Milk 500  gm.  (i6|  oz.) 

Eggs 300  gm.  (10  oz.) 

Cream 300  gm.  (10  oz.) 

Rice,  uncooked 100  gm.  (3I  oz.) 

N  in  twenty-four-hour  amounts 8.138 

CaO  in  twenty-four-hour  amounts 1.214 

MgO  in  twenty-four-hour  amounts o-i75 

Calories 1900 


DIARRHEA 

Acute  Diarrhea 
It  seems  almost  unnecessary  to  discuss  this  condition 
from  a  dietetic  point  of  view,  as  the  principles  govern- 
ing the  feeding  of  such  cases  seem  in  adults  generally  so 
well  understood.  After  an  initial  purge  and  a  period  of 
digestive  rest  one  can  give  the  ordinary  fluid  diet  without 
milk,  consisting  of  broths,  egg-albumin  in  water  flavored 
with  orange-  or  lemon-juice,  and  then  gruels,  followed 
later  by  thin  cereals,  scraped  meat,  and  toast.  Fresh 
milk  in  any  form  usually  does  not  agree,  and  is  apt  to 
increase  or  at  least  keep  up  the  diarrhea.  One  should 
not  be  afraid  of  a  generous  amount  of  starvation,  as 
physiologic  rest  to  the  bowel  is  often  aU  that  is  needed. 

Chronic  Diarrhea 
Differing  from  acute  diarrhea  (where  the  cause  is 
practically  always  from  a  gross  dietetic  error) ,  the  causes, 
of  which  chronic  diarrhea  is  only  a  symptom,  are  numer- 
ous. In  order  to  treat  such  a  condition  successfully  one 
must  make  an  accurate  diagnosis,  otherwise  it  is  time 
and  energy  thrown  away.  One  case  in  point:  The 
chronic  diarrhea,  usually  associated  with  a  persistent 
gastric  achylia,  is,  for  the  most  part,  promptly  stopped 

74 


DIARRHEA  7$ 

by  merely  giving  dilute  hydrochloric  acid  regardless  of  a 
diet;  and  often  no  amount  of  dieting  of  any  description 
will  control  this  diarrhea  without  supplying  the  lack  of 
normal  acid.  Hence  one  sees  the  necessity  for  an  accu- 
rate diagnosis  prehminary  to  any  form  of  treatment. 

There  are,  however,  mmierous  cases  of  chronic  diarrhea 
when,  regardless  of  the  imderlying  cause,  there  is  the  need 
of  a  diet  which  fulfils  the  following  conditions: 

(i)  Non-stimulating  and  non-irritating. 

(2)  Easily  digested,  leaving  little  residue. 

(3)  Not  apt  to  ferment. 

(4)  As  astringent  as  possible. 

In  order  to  fulfil  these  conditions  the  articles  of  food 
may  be  divided  into  those  directly  useful,  those  to  be 
avoided,  and  those  possibly  allowable  in  certain  cases. 

Diet  in  Chronic  Diarrhea 

May  take: 

Raw  oysters  (soft  part). 

Clear  soups. 

Fish:  Any  soft,  white-meated,  non-oily  variety. 

Meat:  Beef,  lamb,  chicken,  guinea-hen. 

Cereals :  Farina,  cream  of  wheat,  grape-nuts,  shredded 

wheat,  wheatena,  flaked  rice,  puffed  wheat  or  rice, 

well-boiled  rice. 
Gruels:  Vermicelli. 

Bread:  Stale  bread,  toast,  zwieback,  toasted  crackers. 
Cheese:  Ripe,  American,  Canadian,  cream  or  cottage, 

pineapple. 


76  DIARRHEA 

Desserts:  Gelatin  desserts  made  with  little  sugar, 
farina  pudding  or  almost  any  cereal  pudding,  sim- 
ple cake  at  times  {e.  g.,  sponge),  blanc  mange. 

Drinks:  Water,  tea,  black  coffee,  cocoa,  claret,  dry- 
sherry,  Burgundy,  whisky  or  brandy,  and  water. 

To  be  avoided: 

Milk  (?) :  Some  cases  can  take  it  boiled  or  skimmed. 

Tough  or  oily  fish,  clams,  etc. 

Pork,  veal,  ham,  duck,  goose. 

Pickles,  condiments,  salads,  olives,  etc. 

Green  vegetables,  salads,  fruits,  fresh  or  stewed. 

Hot  breads,  pies,  sweets  of  all  kinds. 

Sweet  wines. 

Articles  allowable  in  certain  cases: 

Malted  milk  can  often  be  used  on  cereals,  and  is  better 

borne  than  fresh  milk.     Fresh  milk  boiled. 
Turkey,  bacon  (crisp),  koumiss,  zoolak,   baked  white 

potato.     Eggs — boiled,  baked,  poached,  omelette, 

scrambled. 
Baked  hubbard  squash,  well-stewed  celery,  creamed 

spinach,  small  boiled  onions.    Boiled  peas  or  lima 

beans  put  through  a  colander,  without  skins. 


OBESITY  DIET 
(RiCHTER.) 

Early  A.  m.  :  Cupful  of  tea,  no  milk  or  sugar. 
Ham,  40  gm.  (i|  oz.). 
I  roll  (dry). 
10  A.  M. :        Fresh  fruit. 
12  A.  M.:        Fresh  fruit. 

2  P.  M. :        Clear  soup,  100  gm.  (3^  oz.) ;  lean  meat, 
plenty    of   green   vegetables    without 
butter  or  milk. 
Salad. 

I  or  2  glasses  of  lemonade  without  sugar. 
Use  saccharin  if  wanted, 
4  p.  M. :        Cup  of  tea. 
6  p.  M.:        Fruit. 

8  p.m.:        75  gm.  (2!  oz.)  of  lean  meat,  radishes, 
potato  (small  one),  sour  pickles. 
Take  one  or  two  steam  baths  per  week. 
Protein,  75  gm.  (2^  oz.);  fat,  50  gm.  (if  oz.);  carbo- 
hydrate, 130  gm.  (4I  oz.);  calories,  1300. 

Comments  on  Obesity  Diet 
The  accumulation  of  fat  in  the  subcutaneous  tissues 
is  due  either  to  an  excess  of  food,  combined  with  too  little 
work,  or  it  is  a  true  disease,  in  which  case  fat  is  de- 
posited in  spite  of  a  small  ration.    In  the  first  instance, 

77 


78  OBESITY  DIET 

diet  alone  is  necessary  for  reduction,  combined  with  ex- 
ercise; in  the  second,  there  must  also  be  other  methods 
used. 

In  order  to  reduce  the  body  weight  it  is  necessary  to 
know  the  number  of  heat  units  which  that  particular 
individual  would  need  if  the  weight  were  the  average 
for  the  height.  This  is  easily  obtained  from  the  tables 
given  (page  97). 

Knowing  what  the  average  weight  should  be,  the 
caloric  needs  are  reckoned  at  30  to  35  calories  per  kilo 
(2.2  pounds).  This  is  sufficient  for  the  body  at  light 
work.  When  the  normal  caloric  need  is  found,  a  diet 
is  constructed  which  will  supply  only  two-thirds,  one- 
half,  or  one-fourth  the  required  normal;  always,  however, 
keeping  the  protein  at  a  good  quantity  to  prevent  un- 
necessary protein  loss,  cutting  down  on  the  fats  and 
carbohydrates  so  that  the  caloric  value  is  kept  low. 
Some  authors  prefer  to  make  the  greatest  reduction  in 
the  fats,  as  they  are  intensive  fat-building  bodies; 
others  prefer  the  reduction  principally  in  carbohydrates. 
A  generous  supply  of  water  is  necessary,  best  taken 
between  meals,  as  water  with  meals  makes  it  easier  to 
take  larger  quantities  of  food;  hence,  water-drinking  at 
meal  time  is  curtailed  to  the  lowest  possible  amount  or 
even  none  allowed. 

The  sample  diet  given  furnishes  a  good  quantity  of 
protein,  but  is  low  in  fat,  carbohydrate,  and  total 
calories. 


GASTRIC  TEST  MEALS 

Ewald:  On  early  morning  fasting  stomach,  give 

White  bread  (no  crust) 40  gm.  (i|  oz.) 

Clear  tea  or  water 400  c.c.  (6  oz.) 

No  butter,  no  sugar  or  milk. 
Express  one  hour  later. 

Leube: 

Clear  beef  soup 4cxd  c.c.  (13I  oz.) 

Beefsteak 200  gm.  (6f  oz.) 

Bread 50  gm.  (if  oz.) 

Water 200  c.c.  (6f  oz.) 

Express  six  hours  later. 

Riegel: 

I  bowl  mutton  broth 200  c.c.  (6f  oz.) 

Beefsteak 200  gm.  (6|  oz.) 

Mashed  potatoes 50  gm.  (if  oz.) 

I  roll  or  piece  of  bread, 

I  glass  of  water 200  c.c.  (6f  oz.) 

Express  six  hours  later. 

Comments  on  Test  Meals 
The  Ewald  test  meal  is  almost  too  well  known  to 
need  any  word  of  explanation,  but  an  outline  of  its  use 
and  a  word  about  routine  in  gastric  diagnosis  may  not 
be  amiss. 

79 


8o  GASTRIC  TEST  MEALS 

Patients  presenting  themselves  for  diagnosis  should 
be  told  to  take  their  usual  supper  or  dinner  the  night 
before  the  examination,  eating  with  the  meal  a  helping 
of  spinach  and  a  few  stewed  prunes  or  dried  raisins. 
These  are  all  easily  recognized  in  the  early  morning 
fasting  stomach  should  there  be  any  actual  retention. 
Nothing  must  be  taken  into  the  stomach  after  this 
meal  until  the  time  of  examination,  not  even  water 
after  lo  p.  m.  The  following  morning  the  stomach-tube 
is  introduced,  and,  by  expression  and  the  use  of  a 
Politzer  bag  or  stiff  rubber  bulb,  an  attempt  made 
(without  the  addition  of  water)  to  obtain  any  possible 
gastric  contents.  Whatever  is  obtained  is  examined  for 
mucus,  free  hydrochloric  acid,  total  acidity,  blood,  and 
microscopically  for  leukocytes,  food  remnants,  and  bac- 
teria. After  this,  or  even  in  case  there  is  nothing  ob- 
tained from  the  fasting  stomach,  the  Ewald  test  meal 
is  given  and  removed  one  hour  later  without  the  addi- 
tion of  water.  ^ 

^  The  following  should  be  about  the  normal  limits  of  gastric  chem- 
istry after  the  Ewald  meal : 

Mucus. — None,  or  very  small  amount. 

Expressed. — Not  over  loo  to  125  c.c. 

Relation  of  Solids  to  Liquids. — i  to  2  or  1  to  3. 

Free  Hydrochloric  Acid. — 15  to  30  (reckoned  in  cubic  centimeters  of 
tV  normal  potassium  hydrate). 

Combined  Acids.— 20  to  30. 

Total  Acidity. — 45  to  60  (reckoned  in  cubic  centimeters  of  potassium 
hydrate  solution). 

Organic  Acids. — Absent. 

Reaction  to'Dilute  Lugol's  Solution. — Mahogany  color  (blue  or  purple, 
indicating  poor  starch  digestion;  reddish  or  yellow,  good  starch  digestion). 


GASTRIC  TEST  MEALS  8l 

The  Riegel  meal  is  often  used  for  the  purpose  of  learn- 
ing what  sort  of  gastric  chemistry  goes  on  in  the  presence 
of  what  might  be  called  a  normal  mixed  meal.  At  times 
the  Ewald  meal  will  show  no  free  acid,  whereas  if  meat  is 
included  this  may  call  out  enough  acid,  if  possible,  to 
give  the  reaction  for  free  acid.  Still  another  reason  for 
giving  the  Riegel  meal  is  that  the  Ewald  meal  is  rather 
an  abnormal  meal  and  not  so  apt  to  call  out  the  full  or 
normally  balanced  secretion  that  the  more  normal  meal 
might. 

The  difference  between  the  result  of  the  examination 
of  this  meal  and  the  Ewald  are:  There  may  be  higher 
acid  values,  the  starch  should  be  better  digested,  and 
blood  reaction  be  present  from  the  meat.  Of  course,  too, 
the  microscopic  examination  shows  the  meat  residue. 

This  meal  or  the  Leube  may  be  given  to  test  the 
motor  eflSciency  of  the  stomach,  as  there  should  be  noth- 
ing left  after  six  and  one-half  to  seven  hours'  digestion 
and  the  stomach  should  be  empty. 

Biuret  Reaction. — Normal,  a  purple  pink. 

Blood  Test. — No  reaction  or  very  faint. 

Microscopic  Examination. — Starch  grains  and  scattered  cell  detritus 
(no  noticeable  number  of  leukocytes,  bacteria,  or  sarcinse  should  be 
present) . 

No  food  from  previous  day  should  be  present. 

For  the  interpretation  of  the  divergences  from  the  normal  finding 
one  is  referred  to  the  regular  text-books  on  Gastric  Diseases.  Any  food 
from  the  previous  supper  must  be  taken  as  an  indication  of  mechanical 
obstruction  at  the  pylorus,  or  possibly  an  extreme  degree  of  motor  in- 
sufficiency. 


SCHMIDT'S  INTESTINAL  TEST  DIET* 

In  the  morning,  0.5  liter  (16  oz.)  milk,  or,  if  milk  does 
not  agree,  0.5  liter  (16  oz.)  cocoa,  prepared  from  20  gm, 
(f  oz.)  cocoa  powder,  10  gm.  (|  oz.)  sugar,  400  c.c. 
(13  oz.)  water,  and  100  c.c.  (3I  oz.)  milk. 

In  the  forenoon,  0.5  liter  (16  oz.)  oatmeal  gruel,  made 
from  40  gm.  (i|  oz.)  oatmeal,  10  gm.  (|  oz.)  butter,  200 
c.c.  (6|  oz.)  milk,  300  c.c.  (10  oz.)  water,  i  egg,  strained. 

At  noon,  125  gm.  (4  oz.)  chopped  beef  (raw  weight), 
broiled  rare  with  20  gm.  (f  oz.)  of  butter,  so  that  the 
interior  will  still  remain  raw. 

To  this  add  250  gm.  (8  oz.)  potato  broth,  made  of 
190  gm.  (6^  oz.)  mashed  potatoes,  100  c.c.  (3^  oz.)  milk, 
and  10  gm.  (|  oz.)  butter. 

In  the  afternoon  as  in  the  morning. 

In  the  evening  as  in  the  forenoon. 

This  diet  consists  of: 

Milk 1.5  Hters  (i|  qt.) 

Zwieback 100  gm.  (3^  oz.) 

Eggs 2 

Butter 50  gm.  (if  oz.) 

Beef 125  gm.  (4  oz.) 

Potatoes 190  gm.  (6|  oz.) 

Oatmeal  (gruel) 80  gm.  (2!  oz.) 

This  contains  protein  102  gm.  (3^  oz.);  fat,  iii  gm. 
(4  oz.);  carbohydrates,  191  gm.  (6|  oz.);  calories,  2234. 

^  Schmidt,  The  Test  Diet  in  Intestinal  Diseases. 
82 


SCHMIDT'S  INTESTINAL  TEST  DIET  83 

Comments  on  Schmidt's  Intestinal  Test  Diet 
Schmidt's  intestinal  test  diet  is  a  convenient  and  uni- 
form diet  for  testing  the  intestinal  functions,  and  gives 
as  a  starting-point  a  feces  of  uniform  composition.  In 
Schmidt's  words,  "  such  a  test  diet  must  be  one  which 
can  be  taken  equally  well  by  healthy  people  as  well  as 
those  suffering  from  an  intestinal  disorder;  it  must  be 
free,  but  not  absolutely  free,  from  waste  matter,  in  order 
that  the  stimulus  ordinarily  furnished  by  the  ingesta 
should  not  be  completely  absent;  it  must  be  capable  of 
supplying  the  minimum,  at  least,  of  calories  required  by 
the  body  (at  rest),  and  must  contain  the  three  chief 
groups  of  food  stuffs  in  proportionate  relation  to  each 
other;  jQnally,  it  must  be  of  simple  composition,  easy 
to  make,  and  uniformly  prepared."  While  this  is  not 
the  only  diet  conceivable  for  such  a  purpose,  there  is  a 
great  advantage  in  the  universal  use  of  a  particular  diet 
for  testing  intestinal  functions,  just  as  we  use  standard 
diets  for  testing  the  gastric  functions,  and  it  is  of  a 
definite  composition  and  the  result  of  its  use  in  many 
cases  can  be  correlated. 


TABLE  OF  CARBOHYDRATE  EQUIVALENTS 

White  bread  and  biscuits  of  various  sorts: 

Grams 7.5  15  30  45  60  75 

Ounces i  i  1  ij  2  i§ 

"  "  "      Grams.  "  " 

Potato 22  44  88  132  176  220 

Hominy  (cooked) 25  50  100  150  200  250 

Oatmeal  (cooked) 40  80  160  240  320  400 

Rice  (cooked) 15  30  60  90  120  150 

Farina  (cooked) 25  50  100  150  200  250 

Shredded  wheat 5  10  20  30  40  50 

Indian-meal  mush 27  54  108  162  216  270 

Macaroni 30  60  120  180  240  300 

Com  bread 10  20  40  60  80  100 

Barker'sglutenfood,  A 102  204  408  612  816  1020 

Barker's  gluten  food,  B    74  148  296  444  592  740 

Barker's  gluten  food,  C    54  108  216  224  432  540 

Almond  meal 65  130  260  390  520  650 

Gum  gluten  (ground) . .   12  24  48  72  96  120 

Soja-bean  meal 50  100  200  300  400  500 

Casoid  flour 55  no  220  330  440  550 

Pure  gluten  biscuit. ...   50  100  200  300  400  500 

Protopuff  No.  I 45  90  180  270  360  450 

Protopuff  No.  2 12  24  48  72  96  120 

Salvia  sticks 25  50  100  150  200  250 

Milk  (whole) 112  224  448  672  896  1120 

Cream 112  224  448  672  896  1120 

Grape-fruit  weighed 

with  skin 187  375  750  1125  1150  1875 

Rice  pudding 14  28  56  84  112  140 

Tapioca  pudding 15  30  60  90  120  150 

Beets  (cooked) 65  130  260  390  520  650 

Custard  (baked) 30  60  120  180  240  300 

Carrots 65  130  260  390  520  650 

Divide  by  30  to  reduce  grams  to  ounces. 
84 


TABLE  OF  CARBOHYDRATE  EQUIVALENTS  85 

Grams. 

Com  (canned  or  green)  .  22  44  88  132  176  220 

Egg  plant 90  180  360  540  720  900 

Parsnips 35  70  140  210  280  350 

Green  peas 30  60  120  180  240  300 

Turnips 56  112  224  336  448  560 

Baked  beans 22  44  88  132  176  220 

Apples 45  90  180  270  360  450 

Bananas 20  40  80  120  160  200 

Oranges 40  80  160  240  320  400 

Peaches 50  100  200  300  400  500 

Pears 50  100  200  300  400  500 

Prunes 24  48  96  144  192  240 

Watermelon 225  450  900 

Divide  by  30  to  reduce  grams  to  ounces. 

The  list  of  food  stuffs  taken  from  Bulletin  28  of  the 
Department  of  Agriculture  are  indispensable  in  reck- 
oning the  protein,  fat,  and  carbohydrate  values  of  foods 
as  well  as  their  caloric  value. 

The  special  recipes  are  appended  and  will  be  found 
useful.  Those  for  diabetics  speak  for  themselves,  while 
the  lactose  jelly  and  ice-cream  will  be  found  a  convem'ent 
method  for  exhibiting  palatably  a  good  number  of 
calories. 

Delafield's  mixture  is  often  serviceable  in  the  feeding 
of  gastric  cases  accompanied  by  much  nausea  and  vomit- 
ing, beginning  with  dram  doses  every  twenty  minutes 
and  gradually  increasing  the  dose,  and  later  lengthening 
the  intervals. 

In  Eiweissmilch  (protein  milk)  we  have  a  preparation 
of  German  origin  which  is  useful,  at  times,  in  conditions 
of  intestinal  disturbance  associated  with  diarrhea.     It 


86  TABLE  OF  CARBOHYDRATE  EQUIVALENTS 

has  been  used,  as  has  Keller's  malt  soup,  particularly 
in  the  feeding  of  children,  but  either  may  be  of  great 
use  in  the  care  of  adults  where  milk,  either  alone  or 
with  the  usual  admixtures,  is  not  well  borne. 

Fisher's  table  of  "standard  portions"  of  loo  calories 
each  forms  the  basis  for  the  easy  computation  and  con- 
struction of  any  of  the  diets.  The  addition  of  the  actual 
amount  of  protein,  fat,  and  carbohydrate  in  the  in- 
dividual portions  simplifies  the  determination  of  the 
amounts  of  these  food  elements  in  any  one  of  the  foods 
listed. 

Thus,  if,  for  example,  we  wish  to  figure  the  actual 
amount  of  food  for  a  day's  ration  in  an  anticonstipation 
diet,  we  take  the  fraction  or  multiples  of  loo  calories  of 
the  foods  called  for.  Slight  rearrangements  are  often 
necessary  to  keep  to  the  approximate  values  set  for  the 
different  diets;  the  following  is  an  example  of  the  method 
for  using  this  table — e.  g.,  for  anticonstipation  breakfast. 


Calories. 

Apple  (i)  (early  A.  m.)  . . .   50 

Oatmeal 100 

Molasses 200 

Biscuit  (johnny  cake) 200 

Egg 100 

Apple  (i) 50 

Prunes 200 

Butter 100 

1000 


Protein. 

Fat. 

Carbohydrate. 

Gm. 

Gm. 

Gm. 

0-3 

0.3 

II.O 

4.4 

0.8 

8.2 

1.6 

48.0 

6.0 

34 

35-0 

7-9 

7.2 

0-3 

0-3 

II.O 

1.4 

10.6 

46.8 

21.Q 

22.6 

160.0 

SPECIAL  DIABETIC  RECIPES  i 

Diabetic  Bread  and  Biscuit 
Akoll  Buiscuit  (Huntly  and  Palmer). 

Carbohydrate,  2.7  per  cent.;  nitrogen,  7  per  cent. 
Each  biscuit  weighs  5.1  gm.  and  contains  0.14  gm. 
carbohydrate  and  0.41  gm.  nitrogen. 
Gluten   meal   biscuit,   made  from   Barker's    Gluten 
Food  A,  to  be  had  of  Herman  B.  Barker,  Somer- 
ville,  Mass. 
Carbohydrate  not  over  4  per  cent.;  nitrogen,  13 
per  cent. 
Soja-bean  meal  biscuit  from  Soja-bean  meal,  to  be 
had  of  Thomas  Metcalf  Company,  Boston,  Mass. 
Protein  (N.  X  6.25),  44.64  per  cent.;  fat,  19.43  per 
cent.;  cane-sugar,  9.34  per  cent.;  starch,  none. 
Casoid  biscuit,  to  be  had  of  Thomas  Leeming  &  Co., 
New  York  City. 
Carbohydrate,  8  per  cent. ;  nitrogen,  10  per  cent. 
Pure  gluten  biscuit  and  potato  gluten  biscuit,  to  be 
had  of  Battle  Creek  Sanitarium  Food  Company. 
Carbohydrate,  10  per  cent.;  nitrogen,  12  per  cent. 
Protopufl  No.  I,  Health  Food  Company,  New  York. 
Carbohydrate,  10  per  cent.;  nitrogen,  12  per  cent. 

^  T.  C.  Janeway  in  Musser  and  Kelly,  Practical  Therapeutics. 

87 


88  SPECIAL  DIABETIC  RECIPES 

Special  Recipes  for  the  Use  of  Oatmeal 
Oatmeal  Popovers: 

Into  the  white  of  i  egg  beaten  lightly  stir  loo  gm. 
(3I  oz.)  of  cooked  oatmeal.  Mix  thoroughly. 
Drop  into  heated  popover  pan.  Bake  twenty 
minutes.    Serve  hot  with  butter. 

Oatmeal  Griddle  Cakes: 

Into  the  beaten  white  of  i  egg  stir  100  gm. 
(3^  oz.)  of  cooked  oatmeal  and  5  gm.  (heaping 
teaspoonful)  melted  butter.  Drop  into  griddle  pan. 
Turn  when  the  oatmeal  is  browned  on  edges.  Serve 
hot  with  plenty  of  butter  and  cinnamon. 

Oatmeal  Muffins: 

To  130  gm.  (2  half-pint  cups)  of  oatmeal,  ground 
as  finely  as  possible  (coffee  grinder),  add  i  heaping 
teaspoonful  Royal  baking  powder  and  ^  teaspoonful 
of  salt.  Mix  well  and  add  i|  cups  of  cold  water, 
and  at  the  end  melted  butter  or  lard  about  half 
the  size  of  an  egg,  28  gm.  (i  oz.).  Beat  well  for  a 
minute,  put  into  buttered  muflfin  pans,  and  bake 
in  a  very  hot  oven. 

SojA-BEAN  Meal 
SojA-BEAN  Meal  Biscuit: 

I  cup  of  cream,  2  eggs,  i  teaspoonful  of  baking 
powder,  salt  to  taste.  Soja-bean  meal  to  make  a 
batter,  not  too  thick.    Make  into  8  cakes. 


SPECIAL  DIABETIC  RECIPES  89 

Muffins: 

Sift  together  thoroughly  i  oz.  of  Soja-bean  flour, 
I  teaspoonful  baking  powder,  and  a  little  salt. 
Stir  1 1  oz.  cold  water  into  flour,  add  melted  butter 
(amount  equal  to  size  of  a  hickory  nut),  beat  the 
white  of  an  egg  and  mix  in  lightly.  Bake  in  two 
buttered  mufl5n  pans  or  molds. 

Pancake: 

Sift  I  tablespoonful  of  Soja-bean  flour  with  a 
little  salt,  add  water  gradually  until  a  thin  batter 
is  made,  beat  in  hard  the  yolk  of  an  egg,  mix  in 
lightly  the  beaten  white  of  an  egg.  Put  all  or  half 
of  the  mixture  in  a  buttered  frying-pan  and  bake 
to  a  nice  brown  on  both  sides. 

Pudding: 

Mix  2^  oz.  of  water,  i  oz.  Soja-bean  flour,  and  a 
httle  salt  together  cold,  boil  in  a  double  boiler  for 
one-half  hour  adding  a  piece  of  butter  the  size  of  a 
hickory  nut.  Beat  up  the  yolk  of  an  egg  imtil 
foamy,  add  to  it  ^  gr.  saccharin  dissolved  in  a  few 
drops  of  water,  a  little  grated  nutmeg,  and  a  Uttle 
cinnamon.  After  the  flour  mixture  has  cooled 
somewhat  stir  it  into  the  beaten  yolk.  Add  the 
beaten  white  of  an  egg  and  bake  in  a  fairly  hot  oven. 

Gluten  Meal  Biscmx: 

To  I  egg  add  i  heaping  saltspoonful  of  salt  and 
beat;  then  add  6  tablespoonfuls  of  cold  water  and 


go  SPECIAL  DIABETIC  RECIPES 

beat  until  quite  thick  or  until  it  becomes  in  quantity 
from  I  to  i^  pints,  and  into  this  beat  i  tablespoonful 
of  thin  cream;  add  2  heaping  tablespoonfuls  of  dry 
gluten;  stir  this  into  the  previous  mixture;  stir 
occasionally  during  one-half  hour  until  of  the  con- 
sistency of  thick  gruel;  bake  thirty-five  minutes  in 
well-buttered  mufl&n  pans  in  hot  oven. 

Desserts 
Baked  Custard: 

1  egg. 

3  tablespoonfuls  cream. 
5  tablespoonfuls  water. 

2  or  3  saccharin  tablets. 
8  drops  vanilla  essence. 

Beat  up  well.  Bake  in  buttered  dish  twenty 
minutes,  with  a  little  nutmeg  grated  on  top. 

Coffee  Ice-cream: 

3  tablespoonfuls  cream. 
3  tablespoonfuls  water. 

2  tablespoonfuls  coffee  with  2  or  3  saccharin 
tablets  dissolved  in  it. 

I  egg. 

Mix  in  saucepan  and  beat  gradually  until  it 
thickens.    Then  cool  and  freeze. 

Cheese  Savory: 

Stir  together  until  very  light  4  tablespoonfuls  each 
of  melted  butter  and  grated  cheese  with  i  table- 


SPECIAL  DIABETIC  RECIPES  91 

spoonful  of  Barker's  gluten  food  A,  2  tablespoonfuls 
cream,  a  flavoring  of  salt  and  cayenne,  and  2  well- 
beaten  eggs.  Pour  into  ramikins  or  cases  made  of 
oiled  paper,  bake  in  a  quick  oven,  and  serve  imme- 
diately. 
Cranberries: 

Stewed  and  sweetened  with  saccharin. 

Diabetic  Milk  (Wright's) 
Definite  quantity  of  milk  diluted  with  three  to  four 
volumes  distilled  water,  to  which  i  or  2 :  1000  glacial 
acetic  acid  has  been  added  (6-12  c.c,  dr.  ii-3,  glacial 
acetic  acid;  i  pint  or  500  c.c.  water).  This  precipitates 
all  casein  and  fat. 

Allow  to  settle,  then  strain  through  calico.  Wash 
repeatedly.  Redissolve  curd  in  a  i  per  cent,  solution 
of  the  following  mixture,  enough  to  make  the  original 
amount  of  milk: 

Sodium  chlorid 11.5 

Potassium  chlorid 9.9 

Monopotassium  phosphate 13.8 

Dipotassium  phosphate lo.o 

Citrate  of  potassium 5.9 

Dimagnesium  phosphate 4.0 

Magnesium  citrate 4.4 

Dicalcium  phosphate 8.0 

Tricalcium  phosphate 9.6 

Calcium  citrate 25.5 

Calcium  oxid 5.5 

Sodium  carbonate 40.0 


92  SPECIAL  DIABETIC  RECIPES 

Analysis  of  Wright's  Diabetic  Milk^ 

Specific  gravity,  loii. 

Ash 0.200  per  cent. 

Fat 3.600 

Protein 1-907 

Carbohydrates 0.015 

Total  solids 5722 

NaCl o.iio 

*  Granat. 


MISCELLANEOUS  RECIPES 
Raised  Bean  Biscuits: 
2  cups  of  bran. 
I  cup  of  entire  wheat  flour. 
Butter,  salt,  and  baking  powder. 
^  cup  of  molasses,  more  or  less  to  taste. 
i§  cups  of  milk. 

Bake  for  one  hour  in  gems,  in  slow  oven. 
(Eat  one  to  three  a  day,  when  stale.) 

Bran  Crackers  (Foord): 
Butter,  2  cups. 
Buttermilk,  f  cup. 
Molasses  (or  honey),  f  cup. 
White  flour,  i  pint. 
Baking  soda,  2  teaspoonfuls. 
Bran,  ij  quarts. 
Bake  in  flat  crackers,  j  inch  thick  and  2  inches  wide. 

Cream  of  Pea  Soup: 
Canned  peas,  §  cup. 
Salt. 

Water,  i|  oz.  (45  c.c). 
Milk,  6  oz.  (180  c.c). 
Butter,  I  dram  (4  gm.). 
Flour,  I  dram  (4  gm.). 
Lactose,  i  dram  (4  gm.). 

93 


94  MISCELLANEOUS  RECIPES 

Boil  first  three  ingredients,  strain,  and  add  milk, 
melted  butter,  flour,  and  lactose;  season.    Bring 
to  the  boiling-point  and  strain. 
30  c.c.  (i  oz.)  equals  protein  2.6  gm.     Calories,  32. 

Black  Bean  Soup: 

Black  beans,  2  tablespoonfuls. 

Cold  water,  i  cup. 

Seasoning — onion,  celery  salt,  salt,  and  pepper. 

Boil  beans  with  water,  strain,  and  add — 

Milk,  f  cup. 

Butter,  2  drams  (8  gm.). 

Flour,  I  dram  (4  gm.). 

Salt  and  pepper,  q.  s. 

30  c.c.  (i  oz.)  equals  protein  1.98.     Calories,  40. 

Lactose  Jelly: 

Gelatin,  |  teaspoonful 
Cold  water,  2  teaspoonfuls 
Orange  Juice,  i^  oz. 
Lemon  juice,  i  teaspoonful 
Cane-sugar,  i^  teaspoonfuls. 
Sherry,  i  teaspoonful. 
Lactose,  3  tablespoonfuls  (i^  oz.). 
Boiling  water,  i|  oz. 

Lactose  is  boiled  in  water  until  clear.  Pour 
over  soaked  gelatin  to  dissolve  and  add  other  parts. 
Strain  through  double  gauze  and  chill. 

May  also  be  flavored  with  grape  or  raspberry  Juice. 


>  I  portion. 


MISCELLANEOUS  RECIPES  95 

Artificial  Buttermilk: 

I  quart  fresh  milk  (fat-free  preferable).  Sterilize 
at  temperature  of  212°  F.  for  twenty  minutes. 
Cool  to  98°  F.  and  put  in  sterile  bottle.  Add  i  tube 
(i  c.c.)  of  lactobacillin  (The  Ferment  Co.).  Allow 
to  stand  at  temperature  of  95°  F.  for  twenty-four 
hours.  Beat  thoroughly  with  Dover  egg-beater 
and  chill. 

For  large  quantity,  use  ^  bottle  of  lactobacillin 
to  one  can  of  milk. 

Protein  Milk  (Eiweissmilch) 

Heat  I  quart  of  whole  milk  to  100°  F,  Add  4  teaspoon- 
fuls  of  essence  of  pepsin  and  stir.  Let  the  mixture  stand 
at  100°  F.  until  the  curd  has  formed.  Put  the  mass  in  a 
linen  cloth  and  strain  off  the  whey  from  the  curd. 
Remove  the  curd  from  the  Hnen  cloth  and  press  it  through 
a  rather  fine  sieve  two  or  three  times  by  means  of  a 
wooden  mallet  or  spoon.  Add  i  pint  of  water  to  the 
curd  during  this  process.  The  mixture  should  now  look 
like  milk,  and  the  precipitate  must  be  very  finely  divided. 
Add  I  pint  of  buttermilk  to  this  mixture.' 

The  composition  of  this  food  is: 

Fats 2.5  per  cent. 

Sugar 1.5         " 

Protein 3.0         " 

Salt 0.5 

I  quart  of  this  milk  contains  about  370  calories. 


96  MISCELLANEOUS  RECIPES 

ELeller's  Malt  Soup 

2  oz.  of  wheat  flour  are  mixed  with  ii  oz.  of  whole 
milk  and  then  passed  through  a  sieve.  In  a  second 
vessel  3  oz.  of  extract  of  malt  are  mixed  with  20  oz.  of 
warm  water.  The  two  mixtures  are  then  poured  into  a 
porcelain  vessel,  2|  dr.  of  11  per  cent,  carbonate  of 
potassium  added,  and  the  whole  cooked  with  constant 
stirring  for  twenty  minutes,  and  then  brought  to  a 
momentary  boil;  any  loss  through  heat  is  made  up  by 
the  addition  of  boiled  water. 

The  composition  of  this  food  is: 

Fats 1.20  per  cent. 

Protein 2.00       " 

Carbohydrates 12.00       " 

Caloric  value,  800  to  the  liter. 

Lactose  Ice-cream 

Cream 120  c.c.  (4  oz.) 

Lactose 30  gm.  (i  oz.) 

Boiling  water 30  c.c.  (i  oz.) 

Cane-sugar 4  gm.  (i  dr.) 

Salt I  gm.  (i  dr.) 

Vanilla i  gm.  (j  dr.) 

Or, 

Sherry 15  c.c.  (^  oz.) 

Boil  lactose  and  water  two  minutes  or  until  clear. 
Mix  with  other  ingredients.   Freeze.    Equals  390  calories. 


miscellaneous  recipes  97 

Delafield's  Mixture 

Feeding  in  nausea: 

Cream 120  c.c.  (4  oz.) 

Milk 120  c.c.  (4  02.) 

Vichy 120  c.c.  (4  oz.) 

Soda  bicarbonate i|  gm.  (20  gr.) 

Cerium  oxalate f  gm.  (10  gr.) 

AVERAGE  WEIGHTS  FOR  MEN  AND  WOMEN 

As  Compiled  by  the  Metropolitan  Life  Insurance 
Company 

Men.  Women. 

Height.  Weight.  Height.  Weight. 

Ft.  In.  Lbs.  Ft.  In.  Lbs. 

5  I 120  4  10 108 

5   2 125  411 112 

5  3 130  5  o 114 

5  4 135  5  1 118 

5  5 141  5  2 123 

5  6 145  5  3 126 

5  7 150    5  4 129 

5  8 154    5  5 133 

5  9 159    5  6 137 

5  10 164    5  7 142 

5  II 169    5  8 146 

6  o 175    5  9 150 

6  I 181    5  10 154 

6  2 188    5  II 158 


AVERAGE   CHEMICAL  COMPOSITION  OF  AMERICAN 
FOODS 

From  Atwater  and  Bryant  (Abstract),  United  States  Depart- 
ment OF  Agriculture 

(Bulletin  No.  28,  1906) 

Food  Material.  Water.      Protein.         Fat. 

A.     Beef.  Per  cent.    Per  cent.    Per  cent. 

Fresh: 

Chuck,  including  shoulder. .  .65.0  19.2  15.4 

Loin 61.3  19.0  19. 1 

Sirloin  butt,  as  piurchased. .  .62.5  19.7  17.7 

Porterhouse  steak 60.0  21.9  20.4 

Ribs 57.0  17.8  24.6 

Round 67.8  20.9  18.6 


Carbohy- 
drates. 

Per  cent. 


Calories 

per  100 

gm.> 


222 

255 
246 
280 
302 
184 


Beef  Organs: 

Brain 80.6  8.8  9.3 

Kidney 76.7  16.6  4.8 

Beef  liver 71.2  20.4  4.5 

Sweetbreads,  as  purchased..  .70.9  16.8  12. i 

Tongue 70.8  18.9  9.2 


0.4 
1-7 


122 
"5 
133 
181 
163 


Cooked: 

Roast,  as  purchased 48.2        22.3        28,6 

Round  steak,  fat  removed,  as 

purchased 63.0        27.6  7.7 

Loin  steak : 
Tenderloin,  broiled 54.8        23.5        20.4 


357 
18s 
287 


Canned: 

Boiled  beef ,  as  purchased — 51.8  25.5 

Corned  beef 51 .8  26.3 

Roast  beef,  as  purchased. . . .  58.9  25.9 

*  Locke,  Food  Values. 


22.5 
18.7 
14.8 


314 
282 

243 


CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS     99 


Food  Material.  Water. 

B.     Veal.  Percent. 

Fresh: 

Breast 68.2 

Leg 71-7 

Loin 69.5 

Rib 69.8 

Shoulder  and  flank,  medium 

fat 65.2 

Kidney,  as  purchased 75.8 

C.    Lamb. 
Fresh: 

Breast  or  chuck 56.2 

Leg,  hind 58.6 

Shoulder 51 .8 

Forequarter 55.1 

Hindquarter 60.9 

Cooked: 

Chops,  broiled 47.6 

Leg,  roast 67.1 

D.    Mutton. 
Fresh: 

Chuck,  lean 64.7 

Leg,  hind 63.2 

Shoulder 60.2 

Forequarter 52.9 

Cooked: 
Mutton,  leg,  roast 50.9 

E.    Pork. 
Fresh: 

Ham 50.1 

Pickled,  salted,  and  smoked: 
Ham,  smoked,  boiled,  as  piu:- 

chased 51 .3 

fried,  as  purchased 36.6 

Bacon,  smoked 20.2 


Protein. 
Per  cent. 

Fat. 
Percent. 

Carbohy- 
drates. 

Per  cent 

Calories 
per  100 

20.3 
20.7 
19.9 

II.O 

6.7 

lO.O 

20.2 

9.4 

— 

170 

19.7 

14.4 

.... 

2IS 

16.9 

6.4 

— 

129 

19. 1 

23.6 

298 

18.6 

22.6 

287 

18.I 

29.7 

351 

18.3 

25.8            ... 

31S 

19.6 

I9.I 

258 

21.7 

29.9 

367 

19.7 

12.7 

198 

25.0     22.6 


iS-7    33-4 


17.8 

16.3         .. 

225 

18.7 

17-5 

239 

I7-S 

21.8 

274 

15-6 

30.9 

352 

20.2 

22.2 

lo.s 


22.4 
33-2 
64.8 


313 


37S 


291 
400 
646 


lOO     CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS 


?:: 


Food  Material.  Water. 

^  ^     , .  F.  Sausage  (as  purchased) .   per  cent. 

I  *'(u      Bologna 55.2 

Frankfort 57.2 

.  ^,  ^ork 39-8 

'  v'   sausage  meat 46.2 

G.    Poultry. 
Fresh: 

Chicken,  broiler 69.7 

young,  dark  meat 70.1 

light  meat 70.3 

Duck,  breast 73.9 

Guinea-hen  meat,  not  includ- 
ing giblets 68.9 

Pheasant  meat,  not  including 

giblets 70.0 

Pigeon  meat,  not  including 

giblets 63.2 

Quail    meat,    not    including 

giblets 66.3 

Squabs,  meat,  not  including 

giblets , 56.6 

Turkey,  dark  meat 57.0 

cooked 53. 7 

light  meat 63.9 

cooked 58.5 

Preserved  Poultry  Meat: 

Potted  turkey 56.0 

chicken 56.1 

Canned  chicken  soup 87.1 

gumbo  soup 91.0 

boned  chicken 57.6 

H.    Fish. 
Fresh: 

Cod,  whole 82.6 

Bass,  black,  whole 76.7 

sea,  whole 79.3 

striped,  whole 77.7 

Blackfish,  whole 79.1 


Protein. 
Per  cent. 

Fat. 
Per  cent. 

L^aiDony- 
drates. 

Per  cent. 

Calories 

per  100 

gm. 

18.2 

19.7 

258 

19.6 

18.6 

I.I 

258 

13.0 

44.2 

I.I 

468 

17.4 

32.S 

.... 

374 

20.7 

8.3 

196 

20.8 

8.2 

187 

21.9 

7-4 

184 

22.3 

2-3 

151 

23-4 

6.S 

191 

24.7 

4.6 

180 

22.9 

12. 1 

243 

25-4 

7.0 

208 

18.S 

23.8 

324 

21.4 

20.6 

316 

39-2 

4.3 

26s 

25-7 

9.4 

23s 

34.6 

4.9 

.... 

240 

17.2 

22.0 

•  .   .  • 

306 

19.4 

20.3 

306 

2.9 

3-i 

S-i 

66 

2.4 

0.2 

4.8 

35 

27.7 

12.8 



274 

16.S 

0.4 

1.2 

103 

20.6 

1-7 

1.2 

103 

19.8 

o-S 

1.4 

86 

18.6 

2.8 

1.2 

102 

18.7 

1-3 

I.I 

89 

CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS     loi 


Water. 
Food  Material. 

Fresh:  ^^  *='='»*• 

Bluefish,  entrails  removed. .  .78.5 

Butterfish,  whole 70.0 

Eels,  salt  water 71 .6 

Haddock,  entrails  removed.  .81.7 
Halibut,  steak  or  sections. .  .75.4 

Herring,  whole 72.5 

Mackerel,  whole 73.4 

Perch,  white,  whole 75.7 

as  purchased 28.4 

yellow,  whole 79.3 

Pickerel,  pike,  whole 79.8 

Pike,  gray,  whole 80.8 

Pompano,  whole 72.8 

Pogy  (scup),  whole 75.0 

Salmon,  whole 64.6 

Shad,  whole 70.6 

roe,  as  purchased 71.2 

Smelt,  whole 79.2 

Spanish  mackerel,  whole 68.1 

Trout,  brook,  whole 77.8 

Preserved  and  canned: 

Cod,  salt 53.5 

Herring,  smoked 34.6 

Mackerel,  salt,  dressed 43.4 

Salmon,  canned 63.5 

Sardines,  canned 52.3 

Shellfish,  etc.,  Fresh: 

Clams,  roimd,  removed  from 

shell,  as  purchased 80.8 

Oysters,  solids,  as  purchased .  88.3 
Scallops,  as  purchased 80.3 

I.    Eggs. 

Hens',  uncooked 73.7 

boiled 73.2 

whites 86.2 

yolks 49.S 

Egg,  boiled,  i  ^g  (50  gm.) .  36.6 


Protein. 
Per  cent. 

Fat. 
Per  cent. 

Carbohy- 
drates. 

Per  cent. 

Calorie 

per  io< 

gm. 

19.4 

1.2 

1-3 

90 

18.0 

II.O 

1.2 

176 

18.6 

9.1 

I.O 

x6i 

17.2 

0.3 

1.2 

74 

18.6 

5-2 

1.0 

125 

I9-S 

71 

i-S 

146 

18.7 

7-1 

1.2 

142 

19-3 

4.0 

1.2 

117 

7-3 

I -5 

0.4 

44 

18.7 

0.8 

1.2 

84 

18.7 

0-5 

I.I 

81 

17.9 

0.8 

I.I 

80 

18.8 

7-5 

1.0 

147 

18.6 

S-i 

1.4 

123 

22.0 

12.8 

1.4 

209 

18.8 

95 

1-3 

i6s 

20.9 

3-8 

I-S 

133 

17.6 

1.8 

1-7 

89 

21.5 

9.4 

1-5 

175 

19.2 

2.1 

1.2 

98 

25-4 

0.3 

90 

36.9 

iS-8 



299 

17-3 

26.4 

316 

21.8 

12.1 



201 

23.0 

19.7 



278 

10.6 

I.I 

S.2 

75 

6.0 

1-3 

3-3 

51 

14.8 

0.1 

3-4 

76 

134 

10.5 

159 

13-2 

12.0 

169 

12.3 

0.2 

55 

15-7 

33-3 

376 

6.6 

6.0 

169 

Total,  I  egg. 

..  83 

I02     CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS 

Water. 
Food  Material. 

Per  cent. 

J.    Dairy  Products,  etc. 
(As  Purchased). 

Butter II  .o 

Buttermilk 91  .o 

Cheese,  American,  pale 31.6 

red 28.6 

California  flat 34.0 

Cheddar 27.4 

Cheshire 37.1 

Cottage 72.0 

Dutch 35.2 

Full  cream 34.2 

Limburger 42.1 

Neuchatel 50.0 

Roquefort 29.3 

Swiss 31.4 

Cream 74.0 

Koiimiss 89.3 

Milk,  condensed,  sweetened..  26.9 
xuisweetened       (evapor- 
ated cream) 68.2 

skimmed QO-S 

whole 87.0 

whey 93.0 

K.    Miscellaneous  (As  Pur- 
chased). 

Beef-juice 93.0         4.9         0.6        ....  25 

Calf's-foot  jelly 77.6  4.3         17.4  89 

Oleomargarine 9.5  r.2        83.0        777 

VEGETABLE  FOOD. 
A.   Flour,  Meals,  etc. 

Barley  meal  and  flour 11.9 

Buckwheat  flour 13.6 

Commeal,  granular 12.5 

Com  Preparations: 

Cerealine 10.3 

Hominy 11. 8 

cooked 79.3 


Protein. 
Per  cent. 

Fat. 
Per  cent. 

Carbohy- 
drates. 

Per  cent. 

Calories 

per  100 

gm. 

I.O 

85.0 

795 

3-0 

O-S 

4.8 

36 

28.8 

35-9 

0.3 

453 

29.6 

38.3 

477 

24-3 

334 

4-5 

429 

27.7 

36.8 

4.1 

473 

26.9 

30.7 

0.9 

399 

20.9 

1.0 

4.3 

112 

37-1 

17.7 

316 

25-9 

33-7 

2.4 

430 

23.0 

29.4 

0.4 

369 

18.7 

27.4 

i-S 

337 

22.6 

29-5 

1.8 

375 

27.6 

24.9 

1-3 

443 

2-5 

18.5 

4-S 

201 

2.8 

2.1 

54 

53 

8.8 

8.3 

54-1 

335 

9.6 

9-3 

II. 2 

172 

34 

0.3 

S-i 

37 

3-3 

4.0 

5-0 

72 

1.0 

0.3 

S-o 

28 

10.5 

2.2 

72.8 

362 

6.4 

1.2 

77-9 

357 

9.2 

1.9 

754 

36s 

9.6 

I.I 

78.3 

370 

8.3 

0.6 

79 -o 

364 

2.2 

0.2 

17.8 

84. 

CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS     103 

Water. 
Food  Material. 

Per  cent. 

Com  Preparations:  Oatmeal..  7.3 

boiled 84.5 

gruel 91.6 

water 96.0 

Rolled  oats 7.7 

Rice 12.3 

boiled 72.5 

flaked 9.5 

flour 8.5 

Rye  flour 12.9 

meal 11. 4 

Wheat,  entire 11.4 

gluten 12.0 

Graham 11 .3 

Prepared  (self-raising) 10.8 

Wheat  Preparations: 

Cracked  and  crushed lo.i 

Farina 10.9 

Flaked 8.7 

Gems 10.4 

Glutens 8.9 

Macaroni 10.3 

cooked 78.4 

Noodles 10.7 

Shredded 8.1 

Spaghetti 10.6 

Vermicelli ii.o 

B.  Bread,  Crackers,  Pastry, 
ETC.  (As  Piurchased). 

Bread: 

Brown 43.6 

Com  (johnny  cake) 38.9 

Rye 35-7 

Wheat: 

Bims 29.0 

Cinnamon 23 .6 

Currant 27.5 


Protein. 
Per  cent. 

Fat. 
Per  cent. 

Carbohy- 
drates. 

Per  cent. 

Calories 

per  100 

gm. 

16.1 

7.2 

67.S 

410 

2.8 

o.S 

"5 

63 

1.2 

0.4 

6.3 

34 

0.7 

O.I 

2.9 

15 

16.7 

7.3 

66.2 

408 

8.0 

0.3 

79.0 

359 

2.8 

O.I 

24.4 

112 

7-9 

0.4 

81.9 

371 

8.6 

6.1 

68.0 

370 

6.8 

0.9 

78.7 

359 

13-6 

2.0 

71.S 

367 

13.8 

1.9 

71.9 

369 

14.2 

1.8 

71.1 

367 

133 

2.2 

71.4 

368 

10.2 

1.2 

73 -o 

353 

II. I 

1-7 

75-5 

371 

II.O 

1.4 

76.3 

371 

134 

1.4 

74-3 

373 

lo.s 

2.0 

76.0 

374 

13.6 

1-7 

74.6 

378 

134 

0.9 

74.1 

367 

3-0 

I -5 

15-8 

91 

11.7 

I.O 

75-6 

367 

lo.s 

1.4 

77.9 

375 

12. 1 

0.4 

76.3 

366 

10.9 

2.0 

72.0 

358 

54 

1.8 

47.1 

231 

7.9 

4-7 

46.3 

266 

9.0 

0.6 

53-2 

260 

6.3 

6.5 

57-3 

321 

94 

7.2 

59.1 

347 

6.7 

7.6 

57.6 

334 

I04     CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS 

Food  Material.  Water. 

VEGETABLE  FOOD,    percent. 

Bread,  Wheat:  Hot  cross 36.7 

Graham 35.7 

Biscuit,  home  made 32.9 

soda 22.9 

Rolls,  French 32.0 

Viemia 31.7 

White,  biscuit 35.2 

home-made 35.0 

all  analyses 35.3 

Whole  wheat 38.4 

Zwieback S  .8 

Crackers: 

Soda • 5.9 

Boston  (split) 7.5 

Egg S-8 

Graham 5.4 

Oatmeal 6.3 

Oyster 4.8 

Pretzels 9.6 

Saltines 5.6 

Water 6.4 

All  analyses 6.8 

Cake: 

Bakers' 31 .4 

Chocolate  layer 20.5 

Drop 16.6 

Frosted 18.2 

Fruit 17.3 

Gingerbread 18.8 

Sponge 15.3 

Cookies,  Cakes,  etc.: 

Mollasses  cookies 6.2 

Sugar  cookies 8.3 

Ginger  snaps 6.3 

Lady  fingers 15.0 

Macaroons 12.3 

Doughnuts 18.3 


Protein. 
Per  cent. 

Fat. 
Per  cent. 

Carbohy- 
drates. 

Per  cent. 

Calorie 

per  IOC 

gm. 

7-9 

4.8 

49-7 

281 

8.9 

1.8 

52.1 

267 

8.7 

2.6 

55-3 

287 

9-3 

13.7 

52.6 

381 

8.5 

2-5 

55.7 

287 

8.S 

2.2 

56.5 

287 

8.0 

1.4 

54-3 

269 

9.1 

1.6 

53.3 

270 

9.2 

1-3 

53.1 

268 

9-7 

0.9 

49-7 

251 

9.8 

9.9 

73-5 

434 

9.8 

9.1 

73-1 

424 

II.O 

8.5 

71. 1 

416 

12.6 

14.0 

66.6 

454 

lO.O 

9.4 

73-8 

429 

II.8 

II. I 

69.0 

434 

"•3 

10.5 

70.5 

433 

9-7 

3-9 

72.8 

375 

10.6 

12.7 

68.5 

442 

11.7 

5.0 

75.7 

405 

10.7 

8.8 

71.9 

420 

6.3 

4.6 

59.9 

302 

6.2 

8.1 

64.1 

364 

7-6 

14.7 

60.3 

316 

S-9 

9.0 

64.8 

374 

5-9 

10.9 

64.1 

388 

S-8 

9.0 

63.5 

368 

6.3 

10.7 

65.9 

396 

7.2 

8.7 

75.7 

421 

7.0 

10.2 

73.2 

423 

6.5 

8.6 

76.0 

418 

8.8 

5.0 

70.6 

371 

6.5 

15.2 

65.2 

435 

6.7 

21. 0 

53-1 

441 

CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS     105 


Water. 
Food  Material, 
pjg.  Percent. 

Apple 42.5 

Cream 32.0 

Custard 62.4 

Lemon 47.4 

Mince 41.3 

Squash 64.2 

Puddings: 

Rice  custard 59.4 

Indian  meal 60.7 

Tapioca 64.5 

Tapioca  with  apple 70.1 

Ice-cream 66.9 

C.     Sugars,  Starches,  etc. 
(As  Purchased) 

Candy 

Honey 18.2 

Mollasses,  cane 25.1 

Starch,  tapioca 11.4 

Sugar,  coffee  or  brown 

granulated .' 

maple 

powdered 

D.    Vegetables. 

Artichokes,  as  purchased 79.5 

Asparagus,    cooked,    as    pur- 
chased  91. 1 

Beans,  butter,  green 58.9 

String  beans,  cooked 95.3 

fresh,  as  purchased 83 .0 

Beets,  cooked 88.6 

Cabbage 91 .5 

Carrots,  fresh 88.2 

Cauliflower,  as  purchased 92 .3 

Celery 94.5 

Com,  green 75.4 

Cucimibers 95.4 


Protein. 
Per  cent. 

Fat. 
Per  cent. 

Carbohy- 
drates. 

Per  cent. 

Calories 

per  100 

gm. 

3-1 

9.8 

42.8 

280 

4.4 

II.4 

SI.2 

334 

4.2 

6.3 

26.1 

183 

3-6 

10. 1 

37-4 

262 

5-8 

12.3 

38.1 

294 

4.4 

8.4 

21.7 

i8s 

4.0 

4.6 

31-4 

182 

5-5 

4.8 

27-5 

180 

3-3 

3-2 

28.2 

159 

0-3 

O.I 

293 

122 

5-2 

lO.I 

17.7 

189 

96.0 

391 

>.4 

81.2 

335 

•4 

69.3 

284 

).4 

0 

I         88.0 

364 

95 -o 

389 

lOO.O 

410 

82.8 

339 

100 .0 

410 

2.6 


16.7 


80 


2.1 

3-3 

2.2 

48 

9.4 

0.6 

29.1 

163 

0.8 

I.I 

1.9 

21 

2.1 

0-3 

6.9 

40 

2-3 

0.1 

7-4 

41 

1.6 

0-3 

5.6 

32 

I.I 

0.4 

9-3 

46 

1.8 

o-S 

4-7 

31 

I.I 

0.1 

3-3 

19 

3-1 

I.I 

19.7 

104 

0.8 

0.2 

3-1 

x8 

lo6     CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS 


Food  Material.  Water. 

VEGETABLE   FOOD.    Percent. 

Eggplant 92.9 

Greens,  beet,  cooked,  as  pur- 
chased  89.5 

Lentils,  dried,  as  pvirchased. ...  8.4 

Lettuce 94.7 

Mushrooms,  as  purchased 88.1 

Okra 90.2 

Onions,  fresh 87.6 

prepared,  as  piu-chased 91.2 

Parsnips 83 .0 

Peas,  dried,  as  purchased 9.5 

green 74.6 

cooked,  as  purchased 73.8 

Potatoes,  raw  or  fresh  cooked. .  78.3 

boiled,  as  purchased 75.5 

cooked  chips,  as  purchased . .   2,2 
mashed  and  creamed,   as 

purchased 75.1 

sweet,  raw  or  fresh 69.0 

cooked   and  prepared,  as 

purchased 51.9 

Pumpkins 93.1 

Radishes 91.8 

Rhubarb 94.4 

Sauerkraut,  as  purchased 88.8 

Spinach,  fresh,  as  purchased.  .  .92.3 

cooked,  as  purchased 89.8 

Squash 88.3 

Tomatoes,  fresh,  as  purchased .  .94.3 
Turnips 89.6 

Canned  as  Purchased. 

Asparagus 94.4 

Beans,  baked 68.9 

string 93.7 

lima 79.5 

red  kidney 72.7 

Brussels  sprouts 93.7 

Com,  green 76.1 

Okra 94.4 


Protein. 
Per  cent. 

Fat. 
Per  cent. 

caroony- 
drates. 

Per  cent. 

Calories 

per  100 

gva. 

1.2 

0.3 

S-i 

29 

2.2 

34 

3-2 

54 

25-7 

1.0 

59-2 

357 

1.2 

0.3 

2.9 

20 

3-5 

0.4 

6.8 

46 

1.6 

0.2 

7-4 

39 

1.6 

0-3 

9.9 

49 

1.2 

1.8 

4.9 

42 

1.6 

0.5 

13-5 

66 

24.6 

1.0 

62.0 

36s 

7.0 

o-S 

16.9 

102 

6.7 

3-4 

14.6 

119 

2.2 

0.1 

18.4 

85 

2.5 

0.1 

20.9 

97 

6.8 

39-8 

46.7 

589 

2.6 

3-0 

17.8 

III 

1.8 

0.7 

27.4 

126 

3-0 

2.1 

42.1 

204 

I.O 

0.1 

5-2 

26 

1-3 

0.1 

5-8 

30 

0.6 

0.7 

3-6 

23 

1-7 

o-S 

3.8 

28 

2.1 

0.3 

3-2 

24 

2.1 

4.1 

2.6 

57 

1.4 

o-S 

9.0 

47 

0.9 

0.4 

3-9 

23 

1-3 

0.2 

8.1 

41 

1-5 

0.1 

2.8 

19 

6.9 

2.5 

19.6 

132 

I.I 

O.I 

3-8 

21 

4.0 

0.3 

14.6 

79 

7.0 

0.2 

18.5 

106 

i-S 

O.I 

3-4 

21 

2.8 

1.2 

19.0 

103 

0.7 

O.I 

3-6 

19 

Protein. 

Fat. 

Carbohy- 
drates. 

Calori( 

per  10 

gm. 

Per  cent. 

Per  cent. 

Per  cent. 

3.6 

0.2 

9.8 

S6 

0.8 

0.2 

6.7 

33 

0.9 

0.5 

lo.s 

52 

3-6 

I.O 

18.6 

103 

CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS      107 

Water. 
Food  Material. 

Per  cent. 

Peas,  green 85.3 

Pumpkins 91.6 

Squash 87.6 

Succotash 75.9 

Tomatoes 94.0  i  .2  0.2  4.0  23 

F.    Frtjits,  Berries. 
Apples : 

Edible  portion 84.6 

As  purchased  (refuse,  25.0).  .63.3 
Apricots 85.0 

Bananas: 

Edible  portion 75.3 

As  purchased  (refuse,  35.0).  .48.9 

Blackberries,  as  purchased 86.3 

Cherries,  as  purchased 76.8 

Cranberries,  as  purchased 88.9 

Currants,  as  purchased 85.0 

Figs,  fresh,  as  purchased 79.1 

Grapes,  as  purchased 58.0 

Huckleberries 81 .9 

Lemons: 

Edible  portion 89.3 

As  purchased  (refuse,  30.0).  .62.5 
Muskmelons: 

Edible  portion 89.5 

As  purchased  (refuse,  50.0).  .44.8 

Nectarines 82.9 

Oranges: 

Edible  portion 86.9 

As  purchased  (refuse,  27.0).  .63.4 
Peaches: 

Exiible  portion 69.4 

As  ptirchased  (refuse,  18.0).  .73.3 
Pears: 

Edible  portion 64.4 

As  purchased  (refuse,  lo.o).  .76.0 
Pineapple 89.3 


0.4 

o-S 

14.2 

64 

0-3 

0.3 

10.8 

49 

I.I 



13-4 

59 

1-3 

0.6 

22.0 

lOI 

0.8 

0.4 

14-3 

66 

1-3 

1.0 

10.9 

IS 

0.9 

0.8 

iS-9 

76 

0.4 

0.6 

9.9 

47 

1.5 

12.8 

58 

1-5 

18.8 

84 

1.0 

1.2 

14.4 

74 

0.6 

0.6 

16.6 

76 

1.0 

0.7 

8.S 

45 

0.7 

o-S 

5-9 

32 

0.6 

.... 

9-3 

41 

0.3 



4.6 

20 

0.6 

iS-9 

67 

0.8 

0.2 

11.6 

53 

0.6 

0.1 

8.5 

37 

0.7 

0.1 

9.4 

42 

0.5 

0.1 

7-7 

34 

0.6 

o-S 

14.1 

65 

0.5 

0.4 

12.7 

57 

0.4 

0-3 

9-7 

44 

lo8     CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS 

Food  Material.                   Water.  Protein.  Fat.  ^d^^^'  Calories 

VEGETABLE   FOOD.    Percent.  Percent.  Percent.  Percent.  gm. 

Prunes 79.6  0.9  ....  18.9  8i 

Raspberries,  as  purchased 85.8  i.o  ....  12.6  56 

Strawberries 90.4  i  .0  0.6  7.4  40 

Watermelons: 

Edible  portion 92.4  0.4  0.2  6.7  31 

As  purchased  (refuse,  59.4).  .37.5  0.2  o.i  2.7  13 

Dried. 

Apples,  as  purchased 28.1  1.6  2.2  66.1  298 

Apricots,  as  purchased 29.4  4.7  i.o  62.5  284 

Citron,  as  purchased 19.0  0.5  1.5  78.1  336 

Ciu-rants,  as  purchased 17.2  2.4  1.7  74.2  330 

Dates 15.4  2.1  2.8  78.4  336 

Figs,  as  purchased 18.8  4.3  0.3  74.2  325 

Pears 16.5  2.8  5.4  72-9  360 

Prunes 22.3  2.1  73.3  309 

Raisins 14.6  2.6  2>-Z  76.1  354 

Canned  and  Jellies. 
Preserves,  etc.,  as  purchased: 

Apples,  crab 42.4  o-3  2.4  54.4  247 

sauce 61. 1  0.2  0.8  37.2  161 

Apricots 81.4  0.9  17-3  75 

Blackberries 40.0  0.8  2.1  56.4  254 

Blueberries 85.6  0.6  0.6  12.8  61 

Cherries 77-2  i-i  o.i  21. i  91 

Figs,  stewed 56.5  1.2  0.3  40-9  i73 

Marmalade  (orange  peel) 14.5  0.6  0.1  84.5  349 

Peaches 88.1  0.7  0.1  10.8  49 

Pears 81.1  0.3  0.3  18.0  78 

Strawberries,  stewed 74-8  0.7  24.0  loi 

Prime  sauce 76.6  0.5  0.1  22.3  95 

G.    Nuts. 

Almonds 4.8  21.0  54.9  i7-3  668 

Beechnut 4-o  21.9  S7-4  i3-2  678 

Brazil    nuts    (BerthoUetia    ex- 

celsa),  edible  portion 5.3  17.0  66.8  7.0  720 

Butternuts: 

Juglans cinerea 4-4  27-9  61 .2  3.5  698 


Protein. 
Per  cent. 

Fat. 
Per  cent. 

carDony- 
drates. 

Per  cent. 

Calories 

per  100 

gm. 

6.2 

5-4 

42.1 

246 

S-2 

4-5 

35-4 

208 

5-7 

50.6 

27.9 

608 

6.3 

57-4 

31-5 

689 

IS.6 

65-3 

13.0 

72s 

15-4 

67.4 

II. 4 

737 

2.9 

0.2 

77-S 

332 

25-8 

38.6 

24.4 

564 

19-5 

29.1 

18.S 

427 

29-3 

46.5 

17. 1 

623 

18.4 

64.4 

13.0 

728 

12.9 

48.7 

30-3 

631 

21.6 

28.9 

37-7 

S" 

CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS     109 

Food  Material.  Water. 

Chestnuts:  Per  cent. 

Edible  portion 45.0 

As  purchased  (refuse,  16.0).  .37.8 

Cocoanuts 14.1 

Cocoanut,    prepared,    as    piu:- 

chased 3.5 

Filberts 3.7 

Hickory  nuts 3.7 

Lichi  nuts 17.9 

Peanuts: 

Edible  portion 9.2 

As  purchased  (refuse,  24.5). .  6.9 
Peanut  butter,  as  purchased.  . .  2.1 
Walnuts,  California 2.5 

H.    Miscellaneous. 

Chocolate 5.9 

Cocoa 4.6 

UNCLASSIFIED  FOOD 

MATERIALS. 
Animal  and  Vegetable. 
A.    Soups. 
Home  Made  {As  Purchased). 

Beef 92.9 

Bean 84.3 

Chicken 84.3 

Chowder,  clam 88.7 

Meat  stew 84.5 

Canned  {As  Purchased). 

Asparagus,  cream  of 87.4 

Bouillon 96.6 

Celery,  cream  of 88.6 

Chicken 93 .8 

gvunbo 89.2 

Consomm6 96.0 

Com,  cream  of 86.8 

JuUenne 95.9 

Mock  turtle 89.8 


4.4 

0.4 

I.I 

26 

3-2 

1.4 

9.4 

6S 

lo.S 

0.8 

2.4 

61 

1.8 

0.8 

6.7 

43 

4.6 

4-3 

S-S 

81 

2-5 

3-2 

5-5 

63 

2.2 

0.1 

0.2 

11 

2.1 

2.8 

5-0 

55 

3-6 

0.1 

i-S 

22 

3-8 

0.9 

4-7 

43 

2-5 

0.4 

12 

2-S 

1.9 

7-8 

59 

2.7 

o.S 

13 

5-2 

0.9 

2.8 

41 

no     CHEMICAL  COMPOSITION  OF  AMERICAN  FOODS 


Food  Material.  Water. 

UNCLASSIFIED    FOOD      Percent. 
MATERIAL. 

Mulligatawny 89.3 

Oxtail 88.8 

Pea 86.9 

cream  of  green 87.7 

Tomato 90.0 

Turtle,  green 86.6 

Vegetable 95.7 

B.    Miscellaneous. 

Hash 80.3 

Mincemeat,  commercial 27.7 

home-made 54.4 

Salad,  ham 69.4 

Sandwich,  egg 41 .4 

chicken 48.5 


Protein. 
Per  cent. 

Fat. 
Per  cent. 

Carbohy- 
drates. 

Per  cent. 

Calories 
per  100 

gm. 

3-7 

O.I 

5-7 

40 

4.0 

1-3 

4-3 

46 

3.6 

0.7 

7.6 

52 

2.6 

2.7 

5-7 

60 

1.8 

I.I 

S-6 

41 

6.1 

1.9 

3-9 

S8 

2.9 

o.S 

14 

6.0 

1.9 

9.4 

80 

6.7 

1.4 

60.2 

288 

4.8 

6.7 

32.1 

214 

iS-4 

7-6 

S.6 

157 

9.6 

12.7 

34-5 

299 

12.3 

5-4 

32.1 

232 

STANDARD  PORTIONS 


XII 


CO 

o 

H 

Q 

<J 

H 
CO 


o  "*  a> 


a  o 

<  < 

^  e 

m  I 

o  ^ 


<  w 

^  H 
m  O 
W  « 
O  pL, 

O  o 

li 

«  p 


o 


p 
o 


2S 


I 


r . 

c3^ 


a^8 

<fl  3  c 

—     .2 


"tj-  00 


Tj-         fo  vq    i^  00    rj- 
po  00  vo   (>  ^  d  00 


.5       9*^*1^ 
•§      O    6\  ri   M 


»o   ■^  00  00    >o    M 

x«  tC  to  o  00 


•*    •*    PO    fO 


£-2 


*0    vo  PO  NO 

O      M 


mOO'-'mOOO 


o 

;z; 

=i 

m 

'W 

.     3 

^1 

M    bO 

•  < 

o   ^ 

^^, 

6 

•    u 

M 

CO 

3Q 

M 

W   c/j 

d 

l» 

^ 
« 

•If 

1 

;*^  m 

&-« 

o 

o  i 

On 

M 

CO    S 

a 
.2 

vd 

ti   g 

.2 
< 

o 

Ov 
H 

oo" 

M 

6 

O  en 

ll 

iz; 

tn  13 

a 

•43 

3 

^  8 

bC   cd 

§ 

pq 

O  .<-> 

u 

r- 

!§  § 

■fJ 

Jl 

-^  .3  .S  o 

r2  *C  to  Q 

3  *j  o  .la 

^-  a  o  a 

Ko  W  .5  .<J 


l-H   t3  w   U 


112 


STANDARD  PORTIONS 


1^ 


lO     M      O      <N 


OT3   Q 

"3 13 '2 


t^   o   -o    •* 


"      a  ^ 


00    VO    00 


r^   O^  "1  cs 


U1     M 


8 


<N    00    oq     rf  00    00 

«5     M       H       W       M       « 


Ov  00     O     «0    >J^ 


t^   t^    M   00     r>.    o^    O 


STANDARD  PORTIONS 


"3 


lOC^      COOOOO      COP<      M 


vo    t~    PO    fO    O    M 


V)     t^     M 


r^  d 

6  vd 

00 

M 

M 

d> 

M 

vd 

d 

4 

dv 

00 

V)  so 

t-»  vo 

to  H 

»o 

«s 

00 

00 

00 

•* 

H 

VO 

CO 

fO 

t>. 

Ov 

CO 

o 

VO  t^ 

H   O 

O   <N 

N 

O 

o 

O 

o 

o 

O 

o 

w 

P) 

o 

vo 

M 

vo 

3 

ts.  vo 

Tt 

>o  CO 

r^ 

vo 

Tj- 

■+ 

N 

vo 

Ov 

■* 

CO 

« 

Ov 

t«5 

N 

00 

■4-> 
1 

1/1  00 

CO  fO 

0)  cs 

« 

M 

■<1- 

o 

« 

fO 

c< 

t«5 

CO 

w 

c< 

■* 

lO 

CO 

< 

O    -^ 

PO  CO 

q>  00 

M 

00 

N 

vq 

M 

00 

^ 

fj 

Ov  00 

00 

Ov 

M 

vq 

vq 

"a 

M       M       O       O       O 


Ov  VO 

00  00  t».  CO  CO  o 

Ov  l^  00 

t>.  to  00 

O 

lO  vo 

CO  CO  «  C»  «  M 

vo  00  cvi 

c<  CO  M 

M 

^ 


CS 


a 


s     a 


114 


STANDARD  PORTIONS 


'53  C  <S 

3  g  Q 


^        WHMtHMWMMlOMIHCIIHHMI-l 


c3    oooooMHMdc)^6«dd«vd 


^     a 


o   i«  q> 
6   ■«*■  00 


rj-voo'oq         vqoqc-^q^cJq^"!}■^.^^u^fow 

lOir>Tl-H»0       lOM       Tj-M       COM       CS       l^M       <N       «       W 


M       «5     M 


no's 


8J5 
81 


■<f  r>.   q  00 

•<t  06     M     10    On 


COM     cot>.00    lorot^^fOfOO     iHvd    r^ 


O     Tt-    O     « 

M     O       ^     M 


•«  tn     en 

_tn  bO   60 

^  'S  'S  I 

en  03     en     53 

01  (U     <u     en 


"O   ^g 


hJ  H  H  H 


ss 


m 


o    « 

as 

en    J^ 


•-B 


.2   S 


•2   2   fe  "^ 


-f) 

Xi 

OJ 

-a 

4) 

0 

i,' 

s 

<u 

c<3 

1) 

u  u 

•3 


0>    l^    Ov    ■*    O 

00     w     ^    r*    iH 

M     « 


•  .2  .2 

60  'en  'en     tb 


rf3  _ 

T3  fe  2     "  ^ 

S  «  §)iS  «>  2  s 

a  en  ~  ^  en  pC!   43 

0^  U  oJ^    Q^  O  QJ     O 

C  C  C     a  (3  (3     (3 
0000000 


tC'Z   ^    u^   ~i 


en     o     ^ 
4J    8    « 


-— 7      ^     ey      ty 

:9    <->  ^  ~ 


S  J3 
^     en 

s  § 


•O      (30 


O—       Ul 


■  "o"   D. 


<a     _  is  ^ 


e 

o 
O  U 


i^     m    tn     tn 


:  "3  ^« 


en     V   rrH 


"   T^ 


y*    60    O     o     O     O     O 


O   jg 


60    O) 


(3     S 

O  O 


tn  en  ej 
cei  <u  O 
Ph   Ph  Ph 


CJ       Cd       8}      0} 


o   o 

PL.    Ph 


.S     3 

-     -    o.  o* 
CL|  Pm  !/>  c/: 


o   o 


STANDARD  PORTIONS 


"S 


vq 

r*. 

N 

■* 

■* 

•* 

vq 

t^  \q 

00 

M 

t^ 

O 

^0 

« 
« 

t>. 

S 

«o 

VO 

00    • 

M 

M 

6 

d 

6 

fO 

• 

• 

H 

d 

d 

vq 

q> 

H 

M 

lO  vO 

fO 

t>. 

00 

VO 

M   M 

«r> 

to 

to 

fO 

d 

M 

M 

d 

d 

d 

d   M 

t^    to    t-.    ro 


PJ    vO     M     to 
M     w     o     O 


to    M  l^  00     CO    w»    ^ 

mmmOOhmm 


O 


<«       M       M       H       M 


cc    t/>    to  00 


roqvvq    toq>oqvq   "ooq    •»!• 
r^fO'tfOtotooo   t^'^d\0 


vq    w    M 

O     M     ro 

PI     i-i     w 


O  to  to  O  vO  O  o 
t>-  vO  ^  w  to  l^  Ov 
M      M      M      M      M      C4      M 


8  4)  .9 

«s  g  a,  iS 

S  I-  eS  O 

H  O  hJ  O 


o 

O 

o 
O 


fe    S 


-2 


^  ^ 


5  -« 

O  H 


c3     03 


4>     o) 

S    > 


O.   d   Oi 

<  <  < 


en    <U 

It     o 
OJ   -3 


2   «« 


pqpQpqUUOO&H 


ex 

ST 

Q 

CO 

& 

I 


< 

to" 

CO 


a 
I 


ii6 


STANDARD  PORTIONS 


S„5 


§|-o' 


a  ■*? 

O    o 


Jf       O 


M       M       C4 


MVOOO     WOO     MvO     TtvO'*POfO>OrOO 

WIHMCOt-tt-''-'WMt-tC4WMCIcO 

<s    t>.Tj-tN.woq    r^'*^oqoq    ^o    O    ^ 


M      M 


£P 


a 


&4    »    CD 


OO^P»0>-l>HH 


to    P»     M     M 


«      N      « 


cd  o  ^ 

<=!  X  «3 

^  -^  ^ 

"3  g  "3 

in  en  K 


O  H 


4>     U     ^     4) 


a  .a 


'a' 
c  .S  . 

M    S 

"O  .!- 

i2  i  i  4)  i 
«2  d  13  c  C5 
W  O  O  O  O 


T3     Sj 


«     o 


O     ea    4>     "^ 


-    3 

T3   a 

5     bO 


(3 

3 

^ 

a 

a 

;« 

d 

TJ 

<u 

rt 

a 

a 

3 

«J 

tn    en 


^  b 

to 
n 

& 

<1> 

"^  :^ 

h 

6-2 

^ 

b 

tn    o 

ci 

a 

'v, 

>  W 

o 

o    S 


■3.^ 


d 


dp 


O    ,«    .«J    ,4J    _« 


M    60    to    60      - 

^    ^    d    c    oi 

Ol    Ph    fH 


c    c 

3     3 


STANDARD  PORTIONS 


117 


't  ■^  't  ■*  ''i  ^< 

M       M       N       CI       CO 


^     ■*     0<     CO 


W     00       M 

odd 


M 

!>. 

N 

10    W 

^ 

«'    00 

06 

t^ 

0>    w     N 

ir> 

n 

■*  \o 

©> 

M      !>.  00 

t^ 

t^ 

4J 
1 

c^   4 

M 

t>. 

M 

4  vd  4 

CO 

d 

C«  00     c«    >o 

M       M       O       M       O 


wOOmOOwJiovOOv 


Q 


APPENDIX 
Karell  Treatment  for  Anasarca 
For  First  Five  to  Seven  Days 
8,  12  A.  M.;  4,  8  P.  M.:  Milk,  200  c.c. 
No  other  fluids. 

Eighth  Day 
Milk  as  above. 
10  A.  M.:  I  soft-boiled  egg. 
6  p.  M. :  2  pieces  of  dry  toast. 

Ninth  Day 
Milk  as  above. 

10  A.  M. :  I  soft-boiled  egg  and  2  pieces  of  dry  toast. 
6  p.  M. :  I  egg  and  2  pieces  of  dry  toast. 

Tenth  Day 
Milk  as  above. 

12  NOON.:  Chopped  meat,  rice  boiled  in  milk,  vege- 
tables. 
6  p.  M. :  I  soft-boiled  egg. 

Eleventh  to  Twelfth  Days 

Same  as  tenth  day. 

No  salt  is  used  throughout  diet.  Salt-free  toast  and 
butter  used.  Small  amount  of  cracked  ice  allowed  with 
diet.    All  meat  can  often  advantageously  be  omitted. 

1  From  the  New  York  Hospital  Diet  Lists. 

U9 


I20  APPENDIX 

Comment  on  the  Karell  Diet 
The  usefulness  of  the  Karell  treatment  in  cases  of 
anasarca  is  sometimes  extremely  satisfactory,  and  may 
succeed  in  eliminating  the  edema  in  certain  cases  where 
the  ordinary  salt-poor  diets  fail.  The  limitation  of  the 
fluid  in-take,  together  with  the  low  food  value  and  min- 
imal salt  content,  seem  to  explain  its  action.  Besides 
being  helpful  in  some  nephritic  cases,  it  is  often  of  great 
use  in  fluid  collections  due  to  a  decompensated  heart. 

The  lessened  amount  of  fluid  taken,  of  course,  dimin- 
ishes the  work  of  the  heart,  and  so  favors  restoration  of 
its  function. 

Gastric  Diet 

Von  Leube  Treatm  nt  for  Peptic  Ulcer  ^ 

For  the  first  three  days  neither  food  nor  water  is  to 
be  taken,  the  mouth  being  kept  moist  by  washes.  If 
the  patient  is  very  thirsty,  the  Murphy  drip  may  be 
used.  In  patients  who  are  aged,  debihtated,  or  desic- 
cated by  vomiting  and  insuflScient  nourishment,  the 
first  period  of  starvation  is  limited  to  twenty-four  hours. 
On  the  second  day  2  to  4  ounces  of  Celestine  Vichy  is 
given  every  two  hours,  and  on  the  third  day  alternate 
these  doses  with  albumin-water,  so  that  liquids  are  taken 
every  hour. 

During  this  time  hot  applications,  preferably  by  the 
electric  pad,  are  applied  constantly  to  the  epigastrium. 
On  the  fourth  day  peptonized  milk,  2  ounces,  Celestine 
Vichy,  2  or  3  ounces,  on  alternate  hours  are  begun,  and 
these  quantities  are  increased  every  day  until  8  ounces 
of  each  are  taken.  The  hot  apphcations  are  still  con- 
tinued and  the  patient  kept  quietly  in  bed. 

^  As  modified  by  G.  R.  Lockwood. 


APPENDIX  121 

The  bowels  are  now  kept  open  by  low  simple  enemata. 
If  there  is  any  acidity,  alkaline  powders  are  given,  but 
otherwise  no  medicine  is  taken.  About  the  tenth  day 
are  added,  in  order,  milk-toast,  junket,  and  fine  cereal, 
and  then  one  may  begin  one  of  two  lines  of  treatment: 
If  the  bowels  are  constipated  and  the  breath  offensive, 
start  with  Carlsbad  water,  giving  a  glassful,  hot,  before 
the  first  nourishment.  If  necessary,  one-half  such  dose 
is  to  be  given  the  last  thing  at  night.  If  the  bowels  still 
remain  constipated,  reduce  the  temperature  of  the  Carls- 
bad to  tepid,  giving  practically  a  Markbrunnen  instead 
of  Sprudel.  If  the  bowels  are  not  so  constipated,  and  if 
pain  and  acidity  have  been  permanent  symptoms,  some 
rely  on  nitrate  of  silver,  giving  f  grain  three  times  a 
day  for  three  days,  |  grain  for  three  days,  and  f  grain 
for  three  days,  and  then  repeat  the  cycle.  Diarrhea 
may  follow  such  dosage. 

During  the  third  week  are  added,  in  order,  spaghetti 
and  macaroni,  creamed  mashed  potato,  fine  cereal,  such 
as  hominy  or  cream  of  wheat,  and  creamed  fresh  fish, 
such  as  creamed  halibut.  Any  vegetable  that  is  put 
through  a  sieve,  such  as  pea  pur6e,  or  thick  pur€e 
soups,  without  meat  stock,  may  be  given.  Farinaceous 
desserts,  such  as  farina,  tapioca,  cornstarch,  blanc- 
mange, rice  pudding,  and  custard,  may  also  be  given. 

The  patient  still  remains  in  bed  and  continues  the  use 
of  the  hot  applications.  The  hot  applications  are  used 
regularly,  except  in  cases  with  recent  hemorrhage. 

During  the  fourth  week  the  patient  begins  to  be  up  and 
about  on  the  convalescent  gastric  diets. 


INDEX 


ACHYLIA,  74 

Acidosis,  64 

AkoU  biscuit,  87 

Almond  meal,  84 

Almonds,  108,  117 

Ambulatory  treatment  of  chronic 

peptic  ulcer,  53 
Anasarca,   Karell    treatment    for, 

119,  120 
Anticonstipation  diet,  70 
Antifat  diet,  77 
Apple  pie,  105,  116 

sago  pudding,  116 

sauce,  115 
Apples,  85,  107,  108,  IIS 
Apricots,  107,  108,  IIS 
Arthritis  deformans,  72 
Artichoke,  105 
Asparagus,  105,  113 

cream  of,  soup,  109 
Atwater  and  Bryant,  4,  98 
Average  chemical  composition  of 

American  food  stiiSs,  98 

Bacon,  99 
Baked  beans,  8s 

custard,  90 
Bananas,  85,  107,  115 
Barker's  gluten  flour,  A,  84,  87 

B,  84 

C,  84 
Barley,  102 
Bass,  100 
Bean  soup,  117 


Beans,  baked,  113 

butter,  IDS 

lima,  114 

string,  113 
Beechnuts,  108 
Beef,  98,  109,  III,  112 

soup,  117 
Beef-juice,  102 
Beets,  84,  105 
Biscuit,  home-made,  104 

soda,  104 

whole  wheat,  104 
Black  bean  soup,  94 
Blackberries,  107,  108,  iis 
Blackfish,  100 
Blueberries,  108,  iis 
Bluefish,  loi 
Bouillon,  109 
Bovaird  (D.,  Jr.),  72 
Brain,  98 
Bran  biscuits,  raised,  93 

crackers,  93 
Brazil  nuts,  108 
Bread,  113 

brown,  103 

com,  103 

Graham,  104 

rye,  103 

wheat,  104 
Buckwheat,  102 
Bulletin,  26 

Department  of  Agriculture,  4,  98 
Butter,  102,  112 
Butterfish,  loi 

123 


124 


INDEX 


Buttennilk,  21,  95,  102,  112 
Butternuts,  108 

Cabbage,  105,  114 
Cake,  116 

bakers',  104 

chocolate  layer,  104 

drop,  104 

frosted,  104 

gingerbread,  104 

lady-fingers,  104 

macaroons,  104 

sponge,  104 
Calcium  metabolism,  73 
Caloric  needs,  4 

values,  3 
Calves'-foot  jelly,  102 
Candy,  105 
Canned  beef,  98 
Cantaloupe,  115 
Carbohydrate  equivalents,  65,  84 

tolerance,  determination  of,  64 
Cardiac  disease,  119,  120 
Carrots,  84,  105,  114 
Casoid  flour,  84,  87 
Cauliflower,  105,  114 
Celery,  105,  114 

cream  of,  soup,  109 
Cerealene,  102 
Cheese,  102,  112 

savory,  90 
Cherries,  107,  108 
Chestnuts,  109,  117 
Chicken,  100,  109,  iii,  112 

sandwich,  no 

soup,  100 
Chittenden,  2 
Chlorids  in  urine,  26 
Chocolate,  109 
Chronic  diarrhea,  74 
Citron,  108 
Clam  chowder,  109 


Clams,  loi 
Cocoa,  109 
Cocoanuts,  109 
Cod,  112 

fish,  100 
Coleman,  W.,  16,  20 
Comments  on  anticonstipation  diet, 
70 

on  convalescent  diet,  12 

on  diabetic  diets,  63 

on  fluid  diet,  12 

on  gastric  diets,  50 

on  milk  diet,  12 

on  obesity  diet,  77 

on  purin-free  diets,  32 

on  regular  diet,  11 

on  salt-poor  diets,  24 

on  Schmidt's  intestinal  test  diet, 

83 

on  soft  diet,  12 

on  test  meals,  79 

on  typhoid  fever  diets,  19 
Cormer,  L.  A.,  18 
Consommfi,  109 

soup,  117 
Constipation,  70 
Com,  85,  105,  114 

bread,  84,  113 

cream  of,  soup,  109 
Commeal,  102,  113 
Crackers,  113 

Boston,  104 

egg,  104 

Graham,  104 

oatmeal,  104 

oyster,  104 

sal  tines,  104 

soda,  104 

water,  104 
Cranberries,  91,  107,  115 
Cream,  84,  112 

of  celery  soup,  117 


INDEX 


"S 


Cream  pie,  105,  116 
Creamed  potatoes,  106 
Cucimibers,  105 
Currants,  107,  108 
Custard,  n6 

baked,  84 

pie,  116 

Dairy  products,  102 
Dates,  108 

Delafield's  mixture,  85,  97 
Diabetes,  classification  of  cases,  64 
severe,  diet  in,  68 
treatment,  64 
Diabetic  bread  and  biscuit,  87 
diet,  58 
brandy  in,  59-62 
green  days,  60 
lists,  61 

oatmeal  days,  63 
prohibited  articles,  62 
standard,  with  restricted  pro- 
tein, 59 
strict,  58 
whisky  in,  59-62 
white  wine  in,  59-62 
milk,  69 
analysis,  92 
Wright's,  91 
receipts,  87 
Diarrhea,  74 
chronic,  74 
Diet,   chronic    diarrhea,    food    to 
avoid,  76 
convalescent,  8 
gastric.  No.  i,  48 
No.  2,  48 
gastric,  34 
in  diabetes,  58 
in  diarrhea,  acute,  74 

chronic,  75 
in  gastric  hemorrhage,  34,  51 


Diet  in  gastric  hj^ieracidity,  55 

ulcer,  34,  50,  52 
in  gout,  28 
in  obesity,  77 

caloric  needs,  78 

methods  of  reduction,  78 
in  peptic  ulcer,  34,  50 
liquid,  II 
milk,  II 
modified  milk,  in  t3T)hoid,  16, 17, 

18 
New  York  hospital,  5,  8 
purin-free,  liquid,  27 

soft,  27 
regular  house  diet,  5 
salt-poor,  22-24 
soft,  II 
typhoid,  fluid,  14-17 

soft,  18 
Doughnuts,  104,  116 
Duck,  100 
Duodenal  ulcer,  54 

chronic,  53 

Edema,  24 

Eels,  loi 

Egg  sandwich,  no 

Eggplant,  85,  106,  114 

Eggs,  loi,  117 

boiled,  loi 

whites,  loi 

yolks,  1 01 
Eiweissmilch,  85,  95 
Epigastric  pain,  53 

Faeina,  84 
Figs,  107,  108,  115 
Filberts,  109 
Fish,  100 
Fisher,  C.  I.,  86 
Flatulence,  21 
Flour,  113 


126 


INDEX 


Folin,  27 

Food    values    in    anticonstipation 
diet,  70 
in  convalescent  diet,  lo 
in  gouty  diet,  29 
in  regular  house  diet,  8 
in  soft  diet,  11 
in  typhoid  fluid  diet,  14-18 
soft  diet,  19 

Gastric  diagnosis,  80 

medication  in  peptic  ulcer,  54 

test  meals,  79 

ulcer,  chronic,  53 
Gingerbread,  116 
Ginger  snaps,  104 
Glucose,  52 

gluten  biscuit,  87 

meal  biscuit,  89 
Gouty  diet,  28 
Granulated  sugar,  105 
Grape-fruit,  84 
Grapes,  107,  115 
Green  days,  60,  68 

peas,  85 
Greens,  beet,  106 
Guinea-hen,  100 
Gimi  gluten,  ground,  84 
Gumbo  soup,  100 

Haddock,  ioi 

Halibut,  IOI,  112 

Ham,  99,  III,  112 
salad,  no 

Hash,  no 

Herring,  loi 

Hickory  nuts,  109 

Hominy,  84,  102,  113 

Honey,  105,  117 

Huckleberries,  107 

Huntley  and  Palmer  biscuit,  car- 
bohydrate content  of,  59 


H)^eracidity,  55 
Hyperglycemia,  67 

Ice-cream,  85,  90,  96,  105 
Indian  meal  mush,  84 
pudding,  105,  116 
Intestinal  fermentation,  21 
test  diet,  82 

Janeway,  T.  C.,  48,  S8,  S9-61,  63, 
87 

Karell  treatment   for  anasarca, 

119,  120 
Keller's  malt  soup,  86,  96 
Kidney,  24,  98 
Kinnicutt,  F.  P.,  14,  15 
Koumiss,  102 

Lactobacillin,  95 
Lactose,  15 

ice-cream,  96 

jelly,  8s,  94 
Lamb,  99 

chops,  III 
Lemon  pie,  105,  116 
Lemons,  107 
Lenhartz  diet,  34-50 
recapitulation,  49 
Lentils,  106,  114 
Lettuce,  106 
Lichi  nuts,  109 
Lima  beans,  114 
Liver,  98,  112 
Lockwood,  G.  R.,  120 
Low  calciimi  diet,  72 

Macaroni,  84,  103,  113 
Mackerel,  loi,  112 
Maltose,  52 
Maple-sugar,  105 
Marmalade,  108,  117 


INDEX 


127 


Mashed  potatoes,  106 
Meat,  boiled,  in  gout,  ss 

stew,  109 
Men,  average  weight,  3,  97 
Milk,  112,  113 

condensed,  102 

skimmed,  102 

whey,  102 

whole,  84,  102 
Mince  pie,  105 
Mincemeat,  no 
Miscellaneous  receipts,  93 
Mock  turtle  soup,  109 
Molasses,  105,  117 

cookies,  104 
Mosenthal,  H.,  59 
Mulligatawney  soup,  no 
Mushrooms,  106 
Muskmelons,  107 
Mutton,  99,  III,  H2 

Nausea,  21,  85 

Nectarines,  107 

Nitrate  of  silver  lavage  in  chronic 
peptic  ulcer,  54 

Nitrogen,  calcium,  magnesium- 
fixed  diets,  73 

Noodles,  103 

Oatmeal,  63,  84,  113 

boiled,  103 

days,  63 

griddle-cakes,  88 

gruel,  103 

muffins,  88 

popovers,  88 

water,  103 
Okra,  106 
Oleomargarine,  102 
Onions,  106,  114 
Oranges,  85,  107,  115 


Oxtail  soup,  no 
Oysters,  loi 

Parsnips,  85,  106,  114 
Pea  soup,  93,  no 
Peaches,  85,  107,  115 
Peanut  butter,  109 
Peanuts,  109,  117 
Pears,  85,  107,  108,  116 
Peas,  107,  114 

dried,  106 

green,  106 
Peptic  ulcer,  120,  121 
Peptonized  milk,  52 
Perch,  loi 
Pheasant,  100 
Pickerel,  loi 
Pie,  116 
Pigeon,  100 
Pike,  loi 
Pineapple,  107 
Pogy,  loi 
Pompano,  loi 
Pork,  99,  III,  112 
Potato,  84,  106,  114 

biscuit,  87 
Poultry,  100 
Powdered  sugar,  105 
Pretzels,  104 
Protein  milk,  85,  95 
Protopuff,  Nos.  I  and  2,  84,  87 
Prunes,  85,  108,  115 
Pudding,  116 
Pumpkins,  106,  107 
Pure  gluten  biscuits,  84 
Purin  bodies  in  foods,  30 
Purin-free  foods,  29 

Quail,  100 

Radishes,  106 
Raisins,  108,  115 


128 


INDEX 


Raspberries,  io8,  ii6 
Rectal  alimentation,  51 
Reubner,  3 
Rhubarb,  106 
Rice,  84,  113 

boiled,  103 

custard,  105 

flaked,  103 

pudding,  84,  105,  116 
Richter,  77 
Ripened  milk,  95 
Rolled  oats,  103 
Rolls,  113 

French,  104 

Vienna,  104 
Rye  flour,  103 


Salmon,  ioi 
Salt  elimination,  25,  26 
Salt-free  diet,  22-24 
Salt-poor  diet,  No.  i,  22 

No.  2,  23 

No,  3,  24 
Salvia  sticks,  84 
Sauerkraut,  106 
Sausage,  100 
bologna,  100 
frankfort,  100 
pork,  100 
Scallops,  IOI 
Schaefer,  20 

Schmidt's  intestinal  test  diet,  82 
Shad,  IOI 

Shredded  wheat,  84,  113 
Smelt,  IOI 
Soda  cracker,  16 
Soja-bean  meal,  84,  87 

biscuit,  88 

muflins,  89 

pancakes,  89 

pudding,  89 


Soup,  XI 7 
Spaghetti,  103,  113 
Spinach,  106,  114 
Squab,  100 
Squash,  107 

pie,  105 
Standard  diabetic  diets,  58,  59 

portions,  86 
Steak,  98 
Stew,  meat,  109 
Strawberries,  108,  116 
String  beans,  105 
Succotash,  107,  IIS 
Sugar  cookies,  104 

granulated,  117 
Sweet  potatoes,  106,  114 
Sweetbreads,  98 

Table  of  carbohydrate  equivalents, 

84 
Tapioca,  116 
pudding,  84,  105 
with  apple,  105 
Test  meals,  gastric,  79 

chemistry  of,  80 

Ewald,  79,  80 

Leube,  79,  81 

Reigel,  79,  81 
Tetany,  73 
Tomato  soup,  no 
Tomatoes,  107,  114 
Tongue,  98 
Trout,  IOI 
Turkey,  100,  in 
Turnips,  85,  115 
Turtle  soup,  no 
Tympanites,  21 

Ulcer,  peptic,  120,  121 
Uneeda  biscuit,  carbohydrate  con- 
tent of,  59 


INDEX 


129 


Vanderbilt  clinic  diets,  27,  29,  70 

Veal,  99,  III 

Vegetable  soup,  no 

Vermicelli,  103 

Vogel,  K.,  73 

Vomiting,  21,  85 

von  Leube's  treatment  for  peptic 

ulcer,  120,  121 
von  Noorden,  4,  28 

Walker,  H.  J.,  30 
Walnut,  109 
Watermelon,  85,  108 
Wheat  buns,  103 

cinnamon,  103 

cracked,  103 


Wheat,  currant,  103    . 

entire,  103 

farina,  103 

flaked,  103 

gems,  103 

gluten,  103 

Graham,  103 

shredded,  103 
White  bread,  113 
Widal,  24 
Wolf,  C.  G.  L.,  72 
Women,  average  weight,  3,  97 
Wright's  diabetic  milk,  91 


Zwieback,  104 


9 


Books  for  Nurses 


PUBLISHED   BY 

W.    B.   SAUNDERS   COMPANY 

West  Washington  Square  Philadelphia 

London:    9,  Henrietta  Street,  Covent  Garden 

Sanders'   N  ursing  a  new  work 

Miss  Sanders'  new  book  is  undoubtedly  the  most 
complete  and  most  practical  work  on  nursing  ever 
published.  Everything  about  every  subject  with 
which  the  nurse  should  be  familiar  is  detailed  in 
a  clean  cut,  definite  way.  There  is  no  other 
nursing  book  so  full  of  good,  practical  informa- 
tion— information  you  need. 

Modern  Methods  in  Nursing.  By  Georgiana  J.  Sanders, 
formerly  Superintendent  of  Nurses  at  Massachusetts  Gen- 
eral Hospital.      iznio  of  88i  pages,  with  227  illustrations. 

Cloth,  $2.50  net. 

Aikens'  Home  Nurse's  Handbook 

PRACTICAL 

The  point  about  this  work  is  this:  It  tells  you, 
and  shows  you  ju.st  how  to  do  those  little — but 
none  the  less  important — things  entirely  omitted 
from  other  nursing  books,  or  at  best  only  inci- 
dentally treated.  The  chapters  on  "Home  Treat- 
ments" and  "Every-Day  Care  of  the  Baby," 
stand  out  as  particularly  jractical.  Then  the 
"  Points  to  be  Remembered" — terse,  crisp  re- 
minders— is  a  feature  of  great  value. 

Home  Nurse's  Handbook.  By  Charlotte  A.  Aikens, 
formerly  Director  of  the  Sibley  Memorial  Hospital,  Wash- 
ington, D.C.  i2mo  of  276  pages,  illustrated.  Cloth,  $1.50  net 


Stoney's  Nursing  new  (4.h) edition 

Of  this  work  the  Americaii  J ojirnal  of  Nursing  sa3's:  "It  is  the 
fullest  and  most  complete  and  may  well  be  recommended  as 
being  of  great  general  usefulness.  The  best  chapter  is  the  one 
on  observation  of  sj'mptoms  which  is  very  thorough."  There 
are  directions  how  to  improvise   everything. 

Practical  Points  in  Nursing.  By  Emily  M.  A.  Stoney,  formerly  Super- 
intendent of  tlie  Training  School  for  Nurses  in  the  Carney  Hospital, 
South  Boston,  Mass.    12100,495  pages,  illustrated.    Cloth,  $1.75  net. 


NEW    (3d)    EDITION 


Stoney's  Materia  Medica 

Stoney's  Materia  Medica  was  written  by  a  head  nurse  who 
knows  just  what  the  nurse  needs.  American  Medicine  says 
it  contains  "all  the  information  in  regards  to  drugs  that  a 
nurse  should  possess." 

Materia  Medica  for  Nurses.  By  Emily  M.  A.  Stoney,  formerly  Super- 
intendent of  the  Training  School  for  Nurses  in  the  Carney  Hospital, 
South    Boston,    Mass.    lamo  volume  of  300  pages.    Cloth,  $1.50  net. 


NEW  (3d)  EDITION 


Stoney's  Surgical  Technic 

The  first  part  of  the  book  is  dovoted  to  Bacteriology  and 
Antiseptics;  the  second  part  to  Surgical  Technic,  Signs  of 
Death,  Bandaging,  Care  of  Infants,  etc. 

Bacteriology  and  Surgical  Technic  for  Nurses.  By  Emily  M.  A. 
Stoney.  Revised  by  Frederic  R.  Griffith,  M.  D.,  New  York, 
lamo    volume    of   311    pages,    fully   illustrated.         Cloth,    $1.50  net. 

Goodnow's  First- Year  Nursing  illustrated 

Miss  Goodnow's  work  deals  entirely  with  the  practical  side  of 
first-year  nursing  work.  It  is  the  application  of  text-book 
knowledge.  It  tells  the  nurse  how  to  do  those  things  she  is  called 
upon  to  do  in  her  first  year  in  the  training  school — the  actual 
ward  work. 

First-Year  Nursing.  By  Minnie  Goodnow,  R.  N.,  formerly  Super- 
intendent of  the  Women's  Hospital,  Denver.  lamoof  328  pages, 
illustrated.  Cloth,  $1.50  net. 


Aikens'   Hospital  Management 

This  is  just  the  work  for  hospital  superintendents,  training- 
school  principals,  physicians,  and  all  who  are  actively  inter- 
ested in  hospital  administration.  The  Medical  Record  sdiys,: 
"Tells  in  concise  form  exactly  what  a  hospital  should  do 
and  how  it  should  be  run,  from  the  scrubwoman  up  to  its 
financing." 

Hospital  Management.  Arranged  and  edited  by  Charlotte  A. 
AIKENS,  formerly  Director  o '  Sibley  Memorial  Hospital,  Washing- 
ton, D.  C.      i2mo  of  488  pages,  illustrated.  Clotii,  $3.00  net 

Aikens'  Primary  Studies         new  (2d)  edition 

Trained  Nurse  and  Hospital  Review  says:  "It  is  safe  to  say 
that  any  pupil  who  has  mastered  even  the  major  portion  of 
this  work  would  be  one  of  the  best  prepared  first  year  pupils 
who  ever  stood  for  examination." 

Primary  Studies  for  Nurses.  By  Charlotte  A.  Aikens,  formerly 
Director  of  Sibley  Memorial  Hospital,  Washington,  D.  C.  izmo  of 
437  pages,  illustrated.  Cloth,  $1.75  net 

Aikens'  Training-SchooI  Methods  and 
the  Head  Nurse 

This  work  not  only  tells  how  to  teach,  but  also  what  should 
be  taught  the  nurse  and  how  much.  The  Medical  Record  says: 
"  This  book  is  original,  breezy  and  healthy." 

Hospital  Training-School  Methods  and  the  Head  Nurse.  By  Char- 
lotte A.  Aikens,  formerly  Director  of  Sibley  Memorial  Hospital, 
Washington,  D.  C.    lamo  of  367  pages.  Cloth,  $1.50  net. 

Aikens'    Clinical    Studies       new  (2d)  edition 

This  work  for  second  and  third  year  students  is  written  on  the 
same  lines  as  the  author's  successful  work  for  primary  stu- 
dents. Dietetic  and  Hygienic  Gazette  .says  there  "  is  a  large 
amount  of  practical  information  in  this  book." 

Clinical  Studies  for  Nurses.  By  Charlotte  A.  Aikens,  formerly 
Director  of  Sibley  Memorial  Hospital,  Washington,  D.  C.  i2mo  of 
569  pages,  illustrated  Cloth,  $3.00  net 


Bolduan  and  Grund's  Bacteriology   ready 

The  authors  have  laid  particular  emphasis  on  the  immediate 
application  of  bacteriology  to  the  art  of  nursing.  It  is  an 
applied  bacteriology  in  the  truest  sense.  A  stud}'  of  all  the 
ordinary  modes  of  transmission  of  infection  are  included. 

Applied  Bacteriology  for  Nurses.  By  Charles  F.  Bolduan,  M.  D., 
Assistant  to  the  General  Medical  Officer,  and  Marie  Grund,  M.D., 
Bacteriologist,  Research  Laboratory,  Department  of  Health,  City  of 
New  Yorlc.     lamo  of  i66  pages,  illustrated.  Cloth,  $1.25  net. 


Fiske's  The  Body 


A  NEW  IDEA 


Trained  Nurse  and  Hospital  Review  says  "it  is  concise,  well- 
written  and  well  illustrated,  and  should  meet  with  favor  in 
schools  for  nurses  and  with  the  graduate  nurse." 

Structure  and  Functions  of  the  Body.  By  Annette  Fiske,  A.  M., 
Graduate  of  the  Waltham  Training  School  for  Nurses,  Massa- 
chusetts.    i2mo  of  221  pages,  illustrated.  Cloth,  $1.25  net 

Beck's  Reference  Handbook  new  oTL'^tion 

This  book  contains  all  the  information  that  a  nurse  requires 
to  carry  out  any  directions  given  by  the  physician.  The 
Montreal  Medical  Journal  S2iy^  it  is  "cleverly  systematized  and 
shows  close  observation  of  the  sickroom  and  hospital  regime." 

A  Reference  Handbook  for  Nurses.  By  Amanda  K.  Beck.  Grad- 
uate of  the  Illincis  Training  School  for  Nurses,  Chicago,  III. 
32mo    volume   of   244   pages.    Bound    in  flexible  leather,    $1.23  net; 


JUST 
READY 


Roberts'  Bacteriology  &  Pathology 

This  new  work  is  practical  in  the  strictest  sense.  Written 
specially  for  nurses,  it  confines  itself  to  information  that  the 
nurse  should  know.  All  unessential  matter  is  excluded.  The 
style  is  concise  and  to  the  point,  yet  clear  and  plain.  The  text 
is  illustrated  throughout. 

Bacteriology  and  Pathofogy  for  Nurses.     By  Jay  G  Roberts,  Ph.  G., 
M.  D.,  Oskaloosa,  Iowa,      i^mo  of  206  pages,  illustrated.       $1.25  net. 


DeLee's  Obstetrics  for  Nurses      EDmoS 

Dr.  Delyce's  book  really  considers  two  subjects — obstetrics 
for  nurses  and  actual  obstetric  nursing.  Trained  Nurse  arid 
Hospital  Review  says  the  "book  abounds  with  practical 
suggestions,  and  they  are  given  with  such  clearness  that 
they  cannot  fail  to  leave  their  impress." 

Obstetrics  for  Nurses.  By  Joseph  B.  DeLee.  M.  D.,  Professor  of 
Obstetrics  at  the  Northwestern  University  Medical  School,  Chicago. 
i2mo  volume  of  512  pages,  fully  illustrated.  Cloth,  $2.50  net. 

Davis'  Obstetric  &  Gynecologic  Nursing 

JUST  READY— NEW  (4ih)   EDITION 

The  Trained  Nurse  and  Hospital  Review  says:  "  This  is  one 
of  the  most  practical  and  useful  books  ever  presented  to  the 
nursing   profession."     The  text  is  illustrated. 

Obstetric  and  Gynecologic  Nursing.  By  Edward  P.  Davis,  M.  D., 
Professor  of  Obstetrics  in  the  Jefferson  Medical  College,  Philadel- 
phia,   xirao  volume  of  48a  pages,  illustrated.         Buclcram,  $1.75  net 

Macfarlane's  Gynecology  for  Nurses 

ILLUSTRATED 

Dr.  A.  M.  Seabrook,  Woman's  Hospital  of  Philadelphia,  says: 
"It  is  a  most  admirable  little  book,  covering  in  a  concise  but 
attractive  way  the  subject  from  the  nurse's  standpoint.  You 
certainly  keep  up  to  date  in  all  these  matters,  and  are  to  be 
complimented  upon  your  progress  and  enterprise." 

A  Reference  Handbook  of  Gynecology  for  Nurses.  By  Catharine 
Macfarlane,  M.  D.,  Gynecologist  to  the  Woman's  Hospital  of  Phil- 
adelphia. 32mo  of  150  pages,  with  70  illustrations.  Flexible  leather, 
$1.25  net. 


McKenzie's  Exercise  in  Education  and  Medicine 

Exercise  in  Education  and  Medicine.  By  R.  Tait 
McKenzie,  B.A.,  M.D.,  Professor  of  Physical  Educa- 
tion, and  Director  of  the  Department,  University  of 
Pennsylvania.  Octavo  of  406  pages,  with  346  illustra- 
tions. Cloth,  13.50  net. 


Manhattan  Hospital  Eye,  Ear,  Nose, 
and  Throat  Nursing  illustrated 

This  is  a  practical  book,  prepared  by  surgeons  who  know  the 
nurse's  requirements  in  these  specialties.  New  York  Medical 
/Record  says:  "  Every  side  of  the  question  has  been  fully  taken 
into  consideration." 

Nursing  in  Diseases  of  the  Eye,  Ear,  Nose  and  Throat.  By  the 
Committee  on  Nurses  of  the  Manhattan  Eve,  Ear,  and  Throat  Hospital: 
J.  Edward  Giles,  M.  D.,  Surgeon  in  Eye  Department;  ARTHUR  B. 
Duel,  M.  D.,  (chairman).  Surgeon  in' Ear  Department;  HARMON 
Smith,  M.  D.,  Surgeon  in  Throat  Department.  Assisted  by  JOHN  R. 
Shannon,  M.  D.,  Assistant  Surgeon  in  Eye  Department;  and  John 
R.  Page,  M.  D.,  Assistant  Surgeon  in  Ear  Department.  With  chap- 
ters by  Herbert  B.  Wilcox,  M.  D.,  Attending  Physician  to  the  Hos- 
pital; and  Mi>s  Eugenia  D.  Ayers,  Superintendent  of  Nurses.  lamo 
of  260  pages,  illustrated.  Cloth,  $1.50  net. 

Friedenwald  and  Ruhrah's  Dietetics 
lor    IN  urses  new  (2d)  edition 

This  work  has  been  prepared  to  meet  the  needs  of  the  nurse, 
both  in  training  school  and  after  graduation.  America7i  Jour- 
nal of  Nursing  says  it  "is  exactly  the  book  for  which  nurses 
and  others  have  long  and  vainly  sought." 

Dietetics  for  Nurses.  By  Jui.IUS  Friedenwald,  M.  D.,  Professor 
of  Diseases  of  the  Stomach,  and  JOHN  Ruhrah,  M.'D..  Professor  of 
Diseases  of  Children,  College  of  Physicians  and  Surgeons,  Baltimore. 
12010  volume  of  395  pages.  Cloth,  $1.50  net 

Friedenwald  &  Ruhrah  on  Diet  third  edition 

Diet  in  Health  and  Disease.  By  Julius  Frieden- 
WAi^D,  M.D.,  and  John  Ruhrah,  M.D.  Octavo  vol- 
ume of  764  pages.  Cloth,  $4.00  net. 

Galbraith's  Personal  Hygiene  and  Physical 
Training  for  Women  illustrated 

Personal  Hygiene  and  Physical  Training  for  Women.  By  Anna  M. 
Galbraith,  M.  D.,  Fellow  New  York  Academy  of  Medicine.  i2ino 
of  371  pages,  illustrated.  Cloth,  $2.00  net. 

Galbraith's  Four  Epochs  of  Woman's  Life 

THE  NEW  (2d)  EDITION 

The  Four  Epochs  of  Woman's  Life.  By  Anna  M.  Galbraith,  M.D. 
With  an  Introductory  Note  by  John  H.  Musser,  M.  D.,  University 
of  Pennsylvania.    i2mo  of  247  pages.  Cloth,  $1.50  net. 


McCombs'  Diseases  of  Children  for  Nurses 

NEW  (2d)   EDITION 

Dr.  McCombs'  experience  in  lecturing  to  nurses  has  enabled 
him  to  emphasizey^?/  those pomts  thai  7iurses  most  need  to  know. 
National  Hospital  Record  says:  "We  have  needed  a  good 
book  on  children's  diseases  and  this  volume  admirably  fills 
the  want."  The  nurse's  side  has  been  written  by  head 
nurses,  very  valuable  being  the  work  of  Miss  Jennie  Manly. 

Diseases  of  Children  for  Nurses.  By  Robert  S.  McCombs,  M.  D., 
Instructor  of  Nurses  at  the  Children's  Hospital  of  Philadelphia.  i2ino 
of  470  pages,  illustrated.  Cloth,  $2.00  net 

Wilson's  Obstetric  Nursing  new  (2d)  edition 

In  Dr.  Wilson's  work  the  entire  subject  is  covered  from  the 
beginning  of  pregnane}',  its  course,  signs,  labor,  its  actual 
accomplishment,  the  puerperium  and  care  of  the  infant. 
American  Journal  of  Obstetrics  says:  "  Every  page  empasizes 
the  nurse's  relation  to  the  case." 

A  Reference  Handbook  of  Obstetric  Nursing.  By  W.  Reynolds 
Wilson,  M.D.,  Visiting  Physician  to  the  Philadelphia  Lying-in  Char- 
ity-  32mo  of  35S  pages,  illustrated.  Flexible  leather,  $1.25  net 

American  Pocket  Dictionary   new  (7th)  edition 

The  Trained  Nurse  and  Hospital  Review  says:  "We  have 
had  many  occasions  to  refer  to  this  dictionary,  and  in  every 
instance  we  have  found  the  desired  information." 

American  Pocket  Medical  Dictionary.  Edited  by  W.  A.  Newman 
DORLAND,  A.  M.,  M.  D.,  Loyola  University,  Chicago.  Flexible 
leather,  gold  edges,  Si.oo  net;  with  patent  thumb  index,  $1.25  net 


SECOND 
EDITION 


Lewis'  Anatomy  and  Physiology 

Ntirses  Joarnal of  Pacific  Coast  says  "it  is  not  in  any  sense 
rudimentary,  but  comprehensive  in  its  treatment  of  the  sub- 
jects."    The  low  price  makes  this  book  particularly  attractive. 

Anatomy  and  Physiology  for  Nurses.  By  LeRoy  Lewis,  M.D.,  Lec- 
turer on  Anatomy  and  Physiology  for  Nurses,  Lewis  Hospital,  Bay 
City,  Mich.    i2mo  of  375  pages,  150  illustrations.       Cloth,  $1.75  net 


Boyd's  State  Registration  for  Nurses 

State  Registration  for  Nurses.  By  Louie  CrofT  Boyd,  R.  N.,  Grad- 
uate Colorado  Training  School  for  Nurses.  Price,  50  cents  net. 

Paul's  Materia  Medica  new  (2d)  edition 

A  Text-Book  of  Materia  Medica  for  Nurses.  Bv  George  P.  Paul,  M.D., 
Satnaritan  Hospital,  Troy,  N.  Y.     izmo  of  282  pages.     Cloth,  $1.50  net 

Paul's  Fever  Nursing  new  (2d)  edition 

Nursing  in  the  Acute  Infectious  Fevers.  By  George  P.  Paul,  M.D. 
i2nio  of  246  pages,  illustrated.  Cloth,  $1.00  net. 

Hoxie  &  Laptad's  Medicine  for  Nurses 

JUST  READY— NEW  (2d)   EDITION,  REWRITTEN 

Medicine  for  Nurses  and  Housemothers.  By  George  Howard 
Hoxie,  M.D.,  University  of  Kansas;  and  Pearl  L.  Laptad.  lamo 
of  351  pages,  illustrated.  Cloth,  $1.50  net. 

Grafstrom's  Mechano-therapy  FomSS 

Mechano-therapy  (Massage  and  Medical  Gymnastics).  By  AXEL  V. 
Grafstrom,  B.Sc.    M.D.,     i2mo,  200  page,.  Cloth,  $1  25  net. 

Nancrede's  Anatomy  new  (vth)  edihon 

Essentials  of  Anatomy.  Charles  B.  G.  deNancrede,  M.D.,  Univeis- 
ity  of  Michigan.     i2mo,  4tx)  pages,  180  illustrations.      Cloth,  $1.00  ne.. 

Morrow's   Immediate  Care  of  Injured 

Immediate  Care  of  the  Injurel.  By  i 
York  City  Home  for  Aged  aid  Inf 
242  Illustrations.     Clotl",  $2.50  net.' 

Register's  Fever  Nursing 

A  Text  Book  on  Practical  Fever  Nu's 
M.D.,  North  Carolina  Medical  Coll,>, 
trated. 

Pyle's  Personal  Hygiene 


Immediate  Care  of  the  Injurel.  By  Albert  S.  Morrow,  M.D.,  New 
York  City  Home  for  Aged  aid  Infirm.  Octavo  of  354  pages,  with 
242  Illustrations.    Clotl",  $2.50  net.'  Kew  (2d)    Edition 


A  Text  Book  on  Practical  Fever  Nu-sing.  By  Edward  C.  Register, 
M.D.,  North  Carolina  Medical  Coll,>ge.  Octavo  of  350  pages,  Illus- 
trated. Cloth,  $2.=;o  net 


NEW  (5th)   EDITION 

A  Manual  of  Personal   Hygiene.    Edited  by   Walter  L.  Pyle,  M.D. 
Wills   Eye  Hospital,  Philadelphia.     i2mo,  515  pages,  illus.     $1.50  net 


Morris'  Materia  Medica 


NEW    (7th)  EDITION 

Essentials  of  Materia  Medica,  Therapeutics,  and  Prescription  Writing. 
By  Henry  Morris,  M.D.  Revised  by  W.  A.  Bastedo,  M.D.,  Colum- 
bia University,  N.  Y.    izmo  of  300  pages,  illustrated.   Cloth,  $1.00  net 


Griffith's  Care  of  the  Baby 


NEW  (5th)  EDITION 

The  Care  of  the    Baby.     By  J.  P.  Crozer  GRIFFITH. _M.D.,  Univers- 
ity of  Pennsylvania.     i2mo  of  455  pages,  illustrated.     Cloth,  $1.50  net 


University  of  California 

SOUTHERN  REGIONAL  LIBRARY  FACILITY 

405  Hiigard  Avenue,  Los  Angeles,  CA  90024-1388 

Return  this  material  to  the  library 

from  which  it  was  borrowed. 


DE 
#1 


* 


J\ 


1 


Form  I 


THE  LIBRARY 


'-1^4i■    I  iRKAPy  FACIi  llV 


A     000  354  095     2 


